How HHS is Stoking the Fires of Healthcare Reform Controversy

The Department of Health and Human Services last week issued a statement indicating that nearly 130 million non-elderly Americans could potentially be denied health insurance coverage without provisions for pre-existing conditions included within the Accountable Care Act. While it sounds like a pretty astounding number, HHS supposedly validates this claim by stating that 15 to 30 percent of individuals under 65, while in perfectly good health today, will acquire a pre-existing condition within eight years.

"The Affordable Care Act is stopping insurance companies from discriminating against Americans with pre-existing conditions and is giving us all more freedom and control over our healthcare decision," said HHS Secretary Kathleen Sebelius in a statement announcing the analysis.

Now I'm not one to pat health insurers on the back and tell them that everything they do is A-OK, but given HHS's bold statement, it reeked a bit like rhetoric gone awry. After all, why else would they release this heart-tugging analysis mere hours before the House planned its repeal vote?

Keep in mind that America's Health Insurance Plans (AHIP), the health insurance industry lobbying group, isn't directly opposed to pre-existing coverage rules stating that they support coverage for everyone.

Health plans just want to make sure there are protections in place to keep masses of very sick people from bankrupting them. But the industry association had some strong words for HHS and its report.

"We have long agreed that the individual insurance market needs to be reformed," said Robert Zirkelbach, spokesman for AHIP. "But this report significantly exaggerates the number of people whose coverage is impacted by pre-existing conditions." 

Zirkelbach informed HealthLeaders that most people get their coverage through their employer, which does not take into account pre-existing conditions. Further, he said that nine out of 10 individuals who apply for coverage in the individual market are offered a policy. And HHS's figures don't take into account that many individuals not part of an employer-sponsored or individual policy are eligible for public programs, such as Medicaid.

Not surprisingly, conservative think tanks opposed to what they like to call "Obamacare" similarly weighed in on HHS' analysis. A Heritage Foundation blog called the report's findings "misleading and wildly inaccurate," stating that HHS's report was akin saying, "because millions of Americans live within five miles of the seacoast, they risk being killed by the next hurricane if Congress cuts funding for the Army Corps of Engineers."

As you read HHS' statement further, a bit more reality enters the equation. The department goes on to say that "anywhere from 50 to 129 million (19 to 50 percent) of Americans under age 65 have some type of pre-existing condition," with heart disease, cancer, asthma, high blood pressure, and arthritis cited as examples.

Well, what is it? Fifty or 129 million? That's quite a disparity.

In case you read me wrong, this column isn't about reform bashing or sticking up for the little guy, if that's what ACA has made health insurers. But I was a bit taken aback on how loose HHS was with statistics that, whether intended or not, paint one of its most vital partners in healthcare reform in such a negative light.

There really is no debate surrounding pre-existing conditions or other parts of healthcare reform—it's a done deal with little chance of repeal, at least in the near term. But perhaps HHS, which really holds the cards, should spend less time antagonizing and more time building bridges with those constituents vital to successful reform.