The Mysterious Case of the HHS Secretary, the Reporter and the Pre-Existing Condition

Did you realize that the American Health Care Act (AHCA) recently passed by the Congressional Republican majority will allow insurers to deny coverage for mental illness? Did you realize that the AHCA permits insurers to charge women more than men because they get pregnant? That the AHCA will allow insurers to terminate a family’s coverage if they incur claims that exceed their annual premium for three straight years? That at the urging of Attorney General Jeff Sessions, a group of Republican lawmakers in the Senate has proposed language that would make medical marijuana a pre-existing condition? And that the same group of lawmakers is mulling a requirement that would grant immigration officials sweeping new powers to review records of patients suspected of committing crimes or posing as a loosely-defined “threat to community health.”

Hey, I just made that up. But we have a lot of that going on right now.

Case in point. Journalist Daniel Heyman was arrested after shouting questions repeatedly at HHS Secretary Tom Price. He was charged with disruption of government processes, a misdemeanor, and was released on $5,000 bail. Based on just those facts, that sounds outrageous. Predictably, the story has gone viral with shrieks of gestapo tactics and outraged indignation by the Fourth Estate.

What Mr. Heyman was yelling apparently was a question: whether domestic violence would be considered a pre-existing condition under the AHCA. He was led away by authorities. This fed right into the media and the ACLU wheelhouse: bullying of the press and silence on a very important women’s issue, leaving aside for the moment why physical or mental conditions resulting from domestic violence are different from physical or mental conditions caused by other really heinous acts, even on men.

Heyman apparently was not merely uber rude. Secretary Price was walking down a hallway to an event. This was not a press conference. The complaint claims that Heyman physically was trying to push through Secret Service agents guarding Secretary Price. If true, you just don’t try to push by Secret Service agents to get to a Cabinet member without consequences. Again, if true, getting arrested is the least traumatic thing that might have happened to Heyman under those circumstances. And now he’s a celebrity.

First of all, the idea that a pre-existing condition clause might single out domestic violence or rape for non-coverage is arrant nonsense. Neither the ACA nor the AHCA specify types of illnesses, injuries, or conditions (collectively “condition”) that would be implicated by a pre-existing condition clause. Both flatly prohibit pre-existing condition clauses.

What is true is that the AHCA gives states the authority to allow health insurers to seek certain waivers from the AHCA. The AHCA provides that a state could seek such a waiver to allow insurers to charge applicants a higher premium based on their health status and history if their coverage has lapsed for more than 63 days.

This is not an exemption from the ban of pre-existing condition clauses. Insurers would still have to provide coverage. However, they could charge more under such circumstances, but just for the first year of coverage. Thereafter, such applicants would be charged the same as any other similarly situated subscriber would be charged who did not have a pre-existing condition. Whether any state would actually allow this is sheer conjecture, but even if a state decided to allow this (and doubtless face a firestorm of PR wrath), there surely would be legal and regulatory limits on how much insurers could charge under such circumstances for that first year of coverage.

Understand further that this would occur only when someone let their coverage lapse for more than 63 days. In this day and age, adults would have to be negligent in the extreme to allow that to happen, particularly if they have pre-existing conditions. But we live in a society that increasingly exempts people from facing the consequences of their otherwise unacceptably poor behavior.

OK, so how did it suddenly become a widespread story that the AHCA would allow pre-existing condition clauses to avoid coverage for domestic violence and rape? Because many people only read the headlines, and many headlines are irresponsibly drafted to titillate readers’ fears and prejudices. So, it’s taken on a life of its own, and has become a viral version of the truth. Sort of like accusing the Duke lacrosse team of rape; once said, it feeds into so many stereotypes that all too many in society have, that they instantly believe its truth to their core and refuse to accept any alternate reality.

The May 11, 2017 Opinion Page of the Wall Street Journal had an article by Karl Rove. Yes, Mr. Rove is opinionated and is in a “camp.” Yet, his article was thought-provoking. Its title? Fact Checking Health-Care Hysteria. One of his points: “It’s as if Democrats didn’t even bother reading the GOP bill before attacking it.” Of course, Republicans were guilty of the same behavior with the ACA.

So, my point? As a society, from the media to bloggers to politicians to ready-fire-aim prosecutors, we are too quick to jump to conclusions. We are entirely too entrenched in our views of conservatives vs. liberals/progressives; insurers vs. physicians; etc. These are no longer “camps.” They are no-holds-barred, fight-to-the-death, antagonists. We increasingly are unwilling and unable to consider the other “side’s” arguments and rationally defend our own. We take criticism as the moral equivalent of a house invasion.

It need not be that way. Debate used to be taught for a very good reason. A debater literally had to consider the other side’s argument and counter it in an environment where civility and respect were demanded. Sounds like what the Senate used to be. And what colleges and universities used to be before students started preventing speakers with views different from their own from speaking.

There are so many other examples of this, and in more introspective moments, we know that we’ve lost something fundamental in our society. It needs to be regained. The willingness to courteously and respectfully consider someone else’s position, especially when it clashes with your own, is core to becoming a better advocate. How do you dismantle your opponent’s arguments without listening to them—hearing them out without interruption? Oh, and don’t get me started on interruption.

We have reached a point where the word “tolerance” has taken on a very narrow meaning, usually limited to diversity and inclusion. We live in a society that is told not just to tolerate diversity, but embrace it, and rightly so. But in the ideas-realm, we are maximally intolerant. We end up much as two children on a playground who scream at each other non-stop, reaching no understanding and no resolution of whatever started the screaming in the first place.

Of course, President Trump’s tweeting hasn’t helped; but there are so many other blameworthy elected officials and media pundits that we need not single out any one person.

What do we do about this? It must start with ourselves. Blogs are one of the easiest ways to be uncivil without consequence. The Health Care Blog is a pretty good exception, because so many of us know and respect each other. Perhaps we start here, with rules of courtesy and respect; and fully trying to understand views that clash with our own. Might physicians better understand why insurers require preauthorization? They still may not like it, but if they understood why preauthorization came about, they might change their behavior to eliminate its need. Just an example.

Perhaps we all might strive to be a bit kinder, gentler, and respectful of each other and our views. Of course, counter them fully and forcefully, but do so in a manner that encourages a mutual exchange of information that may make both parties a bit more insightful and understanding.



Categories: Uncategorized

6 replies »

  1. On blogs, people have the ability to be obnoxious while hiding behind anonymity. Blog operators, for their part, have the ability to ban such commenters. They should use it. THCB is pretty civil compared to some that I’ve been on. Some blog operators won’t tolerate ad hominem attacks and make that clear. At others, virtually anything goes.

    Too many people on the extremes of each side view the other side as not just wrong but evil. That’s unfortunate and needs to change. It’s not that hard to disagree without being disagreeable.

  2. Seems way too premature to discuss the AHCA. Needs to go through the Senate.

    “Debate used to be taught for a very good reason. A debater literally had to consider the other side’s argument and counter it in an environment where civility and respect were demanded.”

    Been to a high school debate recently? While our son left high school many years ago we have remained active with the speech and debate team. Public Forum is sort of civil, but only sort of. Varies a lot depending upon the teams and can get downright weird. (Judging them is hell.) However, the interactions in Congress have gotten a bit heated at times.


  3. A couple questions: What “subsidies for the poor” are cut? Subsidies paid to insurance companies? What leads you to the characterization of “ineffective tax credits”, when as I understand it tax credits put $ into poor patients pockets? I may be wrong about how this works, but if it takes $ paid to insurers and gets them into patient pockets, there are many positives to that imho.

  4. I’m all for being civil. actually I’m all for teasing each other–I’ve been calling Michael Cannon a right wing nutjob forever, and I’ve been called a collectivist thug. All in good fun, after all I quote Karl Marx all the time.

    But both sides are getting lost in this AHCA “debate” or lack of it. There are three pretty simple things that are true, if not getting the publicity they deserve. 1) it cuts a huge chunk from medicaid, effectively killing the biggest part of the reduction in uninsurance over time. 2) It cuts subsidies for the poor (turning them into ineffective tax credits) 3) It eliminates a 4% tax on capital gains and dividends–which only rich people pay.

    Everything else is conjecture, but the AHCA–if passed by the Senate as is–makes a very unequal country even more unequal.

  5. “Perhaps we all might strive to be a bit kinder, gentler, and respectful of each other and our views.”

    I think this general one sided discourse was started with the revoking of the Fairness Doctrine at the FCC. It spurred the so called “Right Wing media” attack dogs who did not have to provide balanced viewpoints. Conservatives and Libertarians opposed the doctrine, even Obama opposed the re-establishment of the doctrine, but at least wanted rules on concentrated ownership (Wikipedia).

    There is not really any equivalent “Left Wing” media except those on the rabid right who rant about the left bias of “main stream media”, while exempting Fox news. To them, any discussion of two points of view, is considered left. Even PBS is classed as left even though it’s own mandate is to provide balanced viewpoints. Any so called political discussion on NPR always involves two of more sides.

    So this brings us to the Trump era where hate and ignorance substitute for dialog, and his own serial lying and fake news accusations actually inspire his supporters, and Republicans who refuse to view this as nationally destructive because they have a pet piece of legislation they want passed, despite the collateral damage of the whole agenda.

    This all starts in Washington of course, especially when Mitch McConnell vowed never to work with Obama. So compromise and the general good is now viewed as a weakness, and primaries are a death sport for any moderate candidate. Divide and conquer.

    Here in NC the past long ruling Democrats (read blue dogs) gerrymandered the voting districts, when the Republicans finally gained power, largely because of Democratic corruption, they rejoiced that THEY could now gerrymander the districts back to their side, even though many citizens support a non-partisan commission. Add to that the false claim of wide spread voter fraud (now a Trump “fact” rant) which fuels their push to frustrate groups who they consider Democratic voters through things like voter ID, reduced same day registration, and reduced polling stations around Universities and other places where liberals might congregate.

    It’s all enough to make the strongest advocate of kinder, gentler, angry.