This story was published on Kaiser Health News.
Ensuring that people with pre-existing health conditions can get and keep health insurance is the most popular part of the Affordable Care Act. It has also become a flashpoint in this falls campaigns across the country.
And not only is the ACA, which mostly protects people who buy their own coverage, at risk. Also potentially in the crosshairs are pre-existing conditions protections that predate the federal health law.
Democrats charge that Republicans opposition to the ACA puts those protections in peril, both by their (unsuccessful) votes in Congress in 2017 to “repeal and replace” the law, and via a federal lawsuit underway in Texas.
“800,000 West Virginians with pre-existing conditions in jeopardy of losing their health care,” claimed Sen. Joe Manchin (D-W.Va.).
Republicans disagree. “Pre-existing conditions are safe,” President Donald Trump declared at a rally in West Virginia for Manchins GOP opponent, Patrick Morrisey. Morrisey, West Virginias attorney general, is one of a group of state officials suing to overturn the ACA.
Who is right? Like everything else in health care, its complicated.
What is clear, however, is that voters want protections. Even majorities of Republicans told pollsters this summer that it is “very important” that guarantees of coverage for pre-existing conditions remain law.
Here are some key details that can help put the current political arguments in perspective.
Pre-existing conditions are common.
Pre-existing conditions are previous or ongoing medical issues that predate health insurance enrollment. The problem is that the term is a grab bag whose limits have never been defined. It certainly applies to serious ongoing conditions such as cancer, heart disease and asthma. But insurers also have used it to apply to conditions like pregnancy or far more trivial medical issues such as acne or a distant history of depression.
The Kaiser Family Foundation estimated in 2016 that more than a quarter of adults younger than 65 — about 52 million people — have a pre-existing health condition that likely would have prevented them from purchasing individual health insurance under the pre-ACA rules. (Kaiser Health News is an editorially independent program of the foundation.)
Protections vary by what kind of insurance you have. But what protections people with pre-existing conditions have depends on how they get their coverage. For that reason, its not right to say everyone with health problems is potentially at risk, as Democrats frequently suggest.
For example, Medicare, the federal health program for seniors, and Medicaid, the federal-state health plan for low-income people, do not discriminate in either coverage or price on the basis of pre-existing conditions. The two programs together cover roughly 130 million Americans — nearly a third of the population.
The majority of Americans get their coverage through work. In 1996, Congress protected people with pre-existing conditions in employer-based coverage with the passage of the Health Insurance Portability and Accountability Act, known as HIPAA.
HIPAA was intended to eliminate “job lock,” or the inability of a person with a pre-existing condition (or a family member with a pre-existing condition) to change jobs because coverage at the new job would likely come with a waiting period during which the condition would not be covered.
HIPAA banned those waiting periods for people who had maintained “continuous” coverage, meaning a break of no more than 63 days, and the law limited waiting periods to one year for those who were previously uninsured. In addition, it prohibited insurers from denying coverage to or raising premiums for workers based on their own or a family members health status or medical history.
HIPAA was less successful in protecting people without job-based insurance. It sought to guarantee that people with pre-existing conditions leaving the group market could buy individual coverage if they had remained continuously covered. But the law did not put limits on what individual insurers could charge for those policies. In many cases, insurers charged so much for these “HIPAA conversion” policies that almost no one could afford them.
The Affordable Care Act, passed in 2010, built on those 1996 protections, and specifically sought to help people buying their own coverage. It barred all health insurers from excluding people due to pre-existing conditions, from charging them higher premiums and from imposing waiting periods for coverage of that condition.
While the protections were mostly aimed at the individual insurance market, where only a small portion of Americans get coverage, the ACA also made some changes to the employer market for people with pre-existing conditions, by banning annual and lifetime coverage limits.
Will protections on pre-existing conditions become collateral damage?
In 2017, the GOP-controlled House and Senate voted on several versions of a bill that would have dramatically overhauled the ACA, including its protections on pre-existing conditions. Under the last bill that narrowly failed in the Senate, states would have been given authority to allow insurers to waive some of those protections, including the one requiring the same premiums be charged regardless of health status.
In February, 18 GOP attorneys general and two GOP governors filed suit in federal court in Texas. They charge that because Congress in its 2017 tax bill eliminated the ACAs penalty for not having insurance, the entire federal health law is unconstitutional. Their argument is that the Supreme Court upheld the ACA in 2012 based only on Congress taxing power, and that without the tax, the rest of the law should fall.
The Trump administration, technically the defendant in that case, said in June that it disagreed that the entire law should fall. But it is arguing that the parts of the law addressing pre-existing conditions are so tightly connected to the tax penalty that they should be struck down.
Clearly, if the lawsuit prevails in either its original form or the form preferred by the Trump administration, pre-existing protections are not “safe,” as the president claimed.
Even more complicated, the protections written into HIPAA were rewritten and incorporated into the ACA, so if the ACA in whole or part were to be struck down, HIPAAs pre-existing conditions protections might go away, too.
Republicans in Congress have introduced a series of proposals they say would replicate the existing protections. But critics contend none of them covers as many situations as the ACA does. For example, a bill unveiled by several Republican senators in August would require insurers to offer coverage to people with pre-existing health conditions, but not require coverage of the conditions themselves.
That hasnt stopped Republicans from claiming that they support protections for pre-existing conditions.
“Make no mistake about it: Patients with pre-existing conditions should be covered,” said Wisconsin GOP Senate candidate Leah Vukmir, who is running to unseat Democratic Sen. Tammy Baldwin. Health care has been a major issue in that race, as well as many others. Yet Vukmir was recently hailed by Vice President Mike Pence as someone who will vote to “fully repeal and replace Obamacare.”
Meanwhile, Democrats who are chastising their Republican opponents over the issue are sometimes going a bit over the top, too.
An example is Manchins claim about the threat to coverage for 800,000 people in West Virginia. West Virginias population is only 1.8 million and more than a million of those people are on Medicare or Medicaid. That would mean every other person in the state has a pre-existing condition. A recent study found West Virginia has a relatively high level of pre-existing conditions among adults, but it is still less than 40 percent.
KHNs coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
A collar might help prevent sports-related concussions: Study
Team sports build character, teach discipline and keep your kids healthy, but for some sports, like ..
Team sports build character, teach discipline and keep your kids healthy, but for some sports, like soccer and football, they could also increase their risk of brain injuries. Helping to prevent these injuries, a new neck collar has shown promising results in protecting the brain.
The specialized collar, developed by researchers at the Cincinnati Children's Hospital Medical Center, applies pressure to the back of the neck. This pressure allows the artery in the neck to safely backfill the brain with blood, turning the blood into a cushion that makes it less likely for the brain to move upon impact.
The idea for the collar was born out of “biological mimicry,” Dr. David Smith, a visiting research scientist at the Children's Hospital who led a study that tested the collar, told ABC News.
Essentially, Smith and his colleagues looked to nature to solve a medical issue. “If a woodpecker could repeatedly hit its head and not sustain any head injury, why couldnt this be applied to humans,” Smith said.
The study involved 75 teen girls ages 14 to 18 who played for two local high school soccer teams. Only one team received the collars, and then they played soccer. Both teams were asked to undergo brain scans at the beginning and end of the season, as well as during the off-season.
The scans showed that while the brains of the team that hadnt worn the collars showed signs of damage from head impacts, the brains of the team that had worn the collars remained the same.
The results are encouraging considering that even minor impacts over the course of an athletes career can have long-lasting effects on their cognitive functioning.
Concussions have emerged as a major health concern across the United States, according to the American Academy of Physicians. Emergency departments report more than a million visits annually for traumatic brain injuries, most of which are concussions.
Womens soccer is the third most common cause of concussion in the U.S., and its estimated that 1.6 to 3.8 million sports-related concussions occur each year.
There is a debate as to whether the changes shown in the brain scans can result in long-term cognitive decline. However, the areas of the brain that were affected in this study are involved in behavior, personality, expression, decision-making, and long-term memory. (more…)
Baby box safety doubts raised by experts
Baby boxes are being promoted as a safe alternative to standard cots, bassinets and Moses baskets de..
Baby boxes are being promoted as a safe alternative to standard cots, bassinets and Moses baskets despite a lack of evidence on their safety, experts warn.
The cardboard boxes, which come with items like clothes and blankets and can be used as a bed, are offered to new mums in Scotland and parts of England.
The Royal College of Midwives wants the scheme rolled out across the UK, saying it offers a "more equal start to life".
But experts have raised concerns about how safe the boxes are to sleep in.
Writing in a letter to the BMJ, Prof Peter Blair and colleagues say that, as the evidence stands, the boxes should only be used as a temporary bed if nothing else is available.
The boxes, which come with a mattress, have routinely been given to every expectant mother in Finland since the 1930s.
Scotland started offering the free boxes to new parents last year, while some NHS Trusts in England have had pilot and full schemes in place for up to two years. The boxes are not offered by health bodies in Wales or Northern Ireland.
The Royal College of Midwives says the boxes can reduce the likelihood of babies sleeping unsafely, either on a surface like a sofa or with parents who smoke, drink alcohol, or take drugs, and would particularly benefit those born into deprived environments.
However, Prof Blair and colleagues, including representatives of the cot death charity Lullaby Trust, said there was a lack of evidence into how safe the boxes are for sleeping in.
Compared with cots, bassinets and Moses baskets, it is harder for parents to easily see their babies when they are sleeping in them, they warned. (more…)
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People affected by the contaminated blood scandal “lost everything” and “had to live on the breadlin..
People affected by the contaminated blood scandal "lost everything" and "had to live on the breadline" as they struggled financially, the chairman of the public inquiry says.
In a letter to the Cabinet Office, Sir Brian Langstaff said "decisive action" was needed over the support available.
There is a variety of schemes running across the UK.
Sir Brian said he was concerned about what he heard during the preliminary hearings, which started last month.
The inquiry is expected to last more than two years and is looking into how thousands of people in the 1970s and 1980s were given blood products infected with hepatitis viruses and HIV, and the impact this had on their families.
It will also examine whether there has been any attempt to cover up the scandal.
In his letter to Cabinet Office Minister David Lidington, Sir Brian wrote: "You should be aware that there were considerable concerns during the preliminary hearings about access to and variations in financial support and psychological support, and also concern that not everyone who was infected has been identified.
"During the Commemoration people were heard asking 'where is the compassion?' and describing how they had 'lost everything', had to 'live on the breadline' and 'feel betrayed'.
"Throughout the preliminary hearings there were repeated calls for financial assistance which fully recompenses individuals and families for the losses they have suffered.
"One of the legal representatives said: 'Recently there have been changes to the way in which these funds are administered, but any suggestion that this represents proper compensation for the hurt they have, they are and will continue to suffer, is met with anger and indignation.' (more…)
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