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EDITORIAL: The truth about pre-existing conditions

If you listen to Democrats talk about health care, it sounds as if one-third of Americans are on the brink of death.

During the first presidential debate, Democratic nominee Joe Biden trotted out an oft-repeated line about pre-existing conditions, implying that 100 million people with existing ailments might be thrown off the insurance rolls if the Affordable Care Act is overturned.

That certainly sounds awful, but it’s a massive exaggeration. It takes more than a little Kool-Aid to believe that health insurance companies would refuse to serve so many potential customers. Yes, serious pre-existing conditions can make it more difficult for patients to get insured. But that term does not describe 100 million people. As is often the case in the health care debate, a fact without context can be used to mislead.

The claim that 100 million Americans have a pre-existing condition comes from a 2018 report from the consulting firm Avalere that employs an expansive definition of the term. A pre-existing health condition can range from heart disease to obesity to mental health struggles. But a significant number of those people are among the 130 million individuals who are enrolled in Medicare, Medicaid or CHIP. That leaves about half of Americans with pre-existing conditions looking for private insurance.

Yet the vast majority of those consumers are covered at work. Around 160 million people receive insurance through employer-sponsored plans. Since the mid-1990s, employer-based plans have operated under rules protecting those with pre-existing conditions. Most individuals think favorably of their employer-provided coverage. Just ask Mr. Biden, who during a Democratic primary debate in November noted, “One hundred sixty million people like their private insurance.”

The concern, then, isn’t about 100 million Americans. It’s about a small pool of people with severe pre-existing ailments who can’t afford to purchase insurance in the marketplace. How many? “The Affordable Care Act set up a subsidized transitional plan for anyone with pre-existing conditions denied insurance in the individual market,” The Wall Street Journal recently wrote. “Peak enrollment: about 115,000 in 2013.”

Mr. Biden’s fear-mongering is off by only 870-fold or so.

Unfortunately, the ACA has done significant damage to the individual market. Its onerous requirements resulted in premiums more than doubling from 2013 to 2017. Throughout the country, deductibles shot up and networks narrowed. In 2018, 45 percent of adults without insurance cited high costs as the reason they went without coverage, according to the Kaiser Family Foundation.

There are many reasons health care costs continue to increase. Policy based on misleading talking points rather than on accurate numbers is certainly one of them.

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