It’s About Time for Nationwide Guaranteed Issue

The least defensible practice of private insurance is denying coverage entirely based on pre-existing conditions – cancer in remission, high blood pressure, asthma, diabetes or some other medical history that makes it likely you will actually need to use your medical coverage consistently and/or expensively.  Maine, Massachusetts, New Jersey, New York, Vermont, and Washington State have what are called “guaranteed issue” where state law makes it illegal to deny coverage based on pre-existing conditions.  Although great for the residents of those states, a new interactive map from the Center for American Progress indicates this barely scratches the surface -- it's about time we made guaranteed issue the law of the land.

Go to the interactive map on CAP’s Web site, and click on each of the states to see what percentage of the population has which pre-existing condition, and how many people that translates to.

High blood pressure is a mark against you by insurance analysts because it can lead to serious medical conditions like stroke, heart attacks, heart failure and kidney failure if untreated.  However, if treated, it leads to something good for your health but bad for the company:  the likelihood that they’ll have to shell out money for regular medicine and checkups visits.  If you look at the map, the states most victimized are the ones most consistently dealing with high blood pressure and diabetes.  All the states with guaranteed issue have a normal amount of the population living with high blood pressure.  The real danger states don’t – Tennessee, Mississippi and Alabama all have more than a quarter of the population living with high blood pressure, and they also have high percentages of the population uninsured, particularly Mississippi.  Diabetes is similar – all the guaranteed issue states have average or low percentages of the population with diabetes, while South Carolina and (again) Mississippi are on the high end.

Imagine for a second living in one of those southern states, being part of the 15-20% of the population without insurance through your job, and having high blood pressure.  The odds are pretty good that you would have both conditions at once.  The typical treatments for high blood pressure involve teaching the patient to observe his or her high blood pressure, exercise, diet, regular check-ups with the doctor to monitor progress, and regular medication, usually a diuretic, a beta blocker, or a more aggressive medication to relax and open up the valves of your arteries.  You have a condition, sure, but it’s manageable through vigilance.  Except your job doesn’t offer you insurance, and even though you work full-time and could afford your own plan, you’re denied coverage simply because you’re likely to use it.  What are your options except to self-fund your medication, if you can, pay for your doctor’s expenses out of pocket, if you can, or do precisely what all the literature warns you is the exact wrong way to treat high blood pressure – go without the care of a doctor?  There’s no way around it – this isn’t just a business tactic for private insurance.  It is a practice that deliberately makes the health of the population worse.

A lot has been made of the fact that private insurance is willing to negotiate away the practice of discriminating against customers because of pre-existing conditions.  A lot of hay is being made of the magnanimity of this stance.  But you don’t give a gold-star to companies who have stopped polluting our rivers and streams.  You say, “It’s about time.”  Even with guaranteed issue laws on the books, insurance companies still make hefty profits in Maine, Massachusetts, New Jersey, New York, Vermont and Washington State.

The industry’s newfound willingness to discontinue harming the health of the populace of 44 states, including those most vulnerable to the practice of discrimination on the basis of pre-existing conditions, shouldn’t be given a gold star by the media or anyone else.  It should only be given a gruff, “It’s about time.”

(Photo credit:  Aquilo on Flickr.)