I was listening to a radio talk show early Friday morning after the Republican House and President celebrated the rapid passage of their version of repeal of the ACA. While the radio hosts missed the irony, the program cut to an advertisement for a genetic testing company that was promoting its product, touting that it could tell us with a simple biological test the extent of risk we possessed for all types of cancers.
I recalled hearing testimony as part of the Welfare to Work Commission’s 2012 report on Suffolk County poverty where many people spoke of losing everything owned because they were denied treatment by insurers for a relapse in a health condition like breast cancer. The ACA, of course, subsequently eliminated this line of inconsideration by insurance companies.
Tests that might predict such risk weren’t really in significant use pre-ACA. But its potential repeal now re-opens this question – and many more – of what will constitute a “pre-existing condition.” I have personal and family health histories that amount to a WebMD volume of conditions, encompassing both physical and mental health. I know I’m already screwed with respect to possible excising of coverage for a host of conditions I’ve actually experienced, including two types of cancer. I know my risks of worsening or relapse of my conditions, so I do what I can to maintain a healthy lifestyle in order to minimize my risks.
But, what if I take a test and learn that I also have a 10 percent chance of Alzheimer’s or other conditions I have not yet experienced? Will this new information preclude me from coverage or care by a commercial insurer? If I don’t take the test, and nobody knows my pre-disposition, am I still eligible for coverage for that and related conditions? Or, will my insurer get really “progressive” and require diagnostic tests before telling me how much my insurance will cost?
How about new data from the population health world that indicates that even more than our genetic code, it’s our zip code that is often a strong determinant of our health and our healthcare needs? Just like homeowners and auto insurance, will our access to health insurance vary by the neighborhood we choose? (One gnarly congressman was quoted Thursday, “well you will always have the right to move.”).
I told the financial planners in my Rotary Club that they are in a great place under Trumpcare because we will all have to put off retirement pretty much until death so we can put away more dollars just in case any of our loved ones gets sick or disabled…or worse.
This issue will require a lot of public information at a time when fewer people consider information that comes in a form containing more than 140 characters. Some can endure a Facebook post (especially if there’s a funny video) and a few enlightened people will dig deeper and read a one-page blog or two. Recall how the brief non-fact of “Obamacare death panels” impacted public opinion during the ACA debate.
Another House Member admitted Thursday that he didn’t even read the bill, brief as it was, before voting on it. That’s the new stylistic challenge for the President: To issue a profound Tweet that will make good public policy, be it health care, taxes, immigration, or launching a missile attack.
It sure seems unfair that the people who are making the rules and are responsible for thinking through the all their implications are themselves exempt from the impact of the new rules.