A once-obscure health insurance buzzword — pre-existing conditions — is taking over the U.S. Senate race in Missouri. And the seemingly narrow issue could have a wider effect on the federal health care law, depending on whether Republicans maintain control of the Senate after the Nov. 6 midterm election.
Before 2014, when parts of the so-called Affordable Care Act took effect, insurance companies could deny coverage to customers who already had been diagnosed with anything from diabetes to depression.
Almost a third of people in Missouri have pre-existing conditions, and GOP Senate candidate Josh Hawley has said he’s looking out for them, especially because his oldest son has an unspecified chronic joint disease. That is, a pre-existing condition.
“We know what that’s like,” Hawley said in a television ad.
But Democrats and incumbent Sen. Claire McCaskill have called out Hawley for what they say is double dealing. That’s because as attorney general, Hawley brought the state into a lawsuit with 19 other Republican-led states that’s aiming to get the federal health care law thrown out on the grounds that it’s unconstitutional.
The lawsuit, McCaskill said Monday on KCUR’s Up To Date, could undermine health care across the board.
“If that lawsuit is successful, it leaves a whole lot of people, and potentially millions of Missourians in a position that they can no longer access coverage just like it was before the ACA,” she said.
Hawley is campaigning behind a plan that he pledges will force insurers to cover pre-existing conditions, though aside from an op-ed in the Springfield News-Leader in August, he hasn’t provided many details.
“It’s an insurance guarantee,” Hawley told reporters Monday after a rally in Riverside, just north of Kansas City. “An insurance access guarantee that says that folks with pre-existing conditions can buy insurance plans just like everybody else, on the same terms as everybody else and then the government guarantees on the back end that that price will remain the same.”
To make this financially workable, the federal government would reimburse insurance companies for each person’s medical costs that go over $10,000 a year. Hawley doesn’t say how this would be paid for.
Going forward with Hawley’s plan could be a major setback for Missouri residents, University of Kansas economist David Slusky said, because “it wouldn’t fix many of the problems the ACA fixed.”
The first step would be to get rid of what Republicans call Obamacare. Doing so would also get rid of the federal subsidies that more than 188,000 Missouri residents get a year (about $1.3 billion total) to help pay for insurance. Without the subsidies, many people would be eligible to buy insurance, but unable to afford care.
“Insurance on its own doesn’t make you healthy,” Slusky said. “You have to be able to use it. It has to cover the conditions you have, and you have to be able to afford the medical bills on the other side of it.”
The health care law also set up lots of basic rules for all insurance plans. If ended, insurers wouldn’t be required to pay for things like maternity care, drug rehab or checkups that currently are free. It could also allow insurance companies to bring back lifetime limits, meaning an insurer could stop paying for the year after medical costs exceeded a certain threshold.
Voter sentiment
Despite the health law’s apparent benefits, skepticism abounds in Missouri — a state that overwhelmingly went for President Donald Trump in the 2016 election. But polls show the vast majority of voters, including most Republicans, support pre-existing condition coverage.
Cheyenne Mauzy-Wicken said she’s mostly been an independent voter for most of her life. But since her 10-year-son son Landon was diagnosed two years ago with aplastic anemia, a rare, potentially deadly blood disorder, health care concerns have pushed her toward voting Democrat.
“They don’t think it’s gone far enough or they think that it has these problems that they didn’t expect,” said Mauzy-Wicken, who lives in Springfield. “So they think, ‘Well, anything that anybody’s doing has got to be better than what we’ve got now.’”
She acknowledged there are plenty of problems with the federal health care law, but she’s baffled by the idea of ditching it.
“I would never dream that the answer there is taking away some of the most popular things that the Affordable Care Act did, and saying, ‘Let’s start over,’” Mauzy-Wicken said.
Alex Smith is a health reporter for KCUR. You can reach him through email: alexs@kcur.org.
