A Federal Court ruled major portions of the ACA or Obamacare as unconstitutional.

These comments are not about Obamacare or the validity of the Court’s decision. The following comments are in relation to the propaganda messaging made by public figures:

“Today’s ruling is an assault on 133 million Americans with preexisting conditions, on the 20 million Americans who rely on the ACA’s consumer protections for health care, and on America’s faithful progress toward affordable health care for all Americans,” California Attorney General Xavier Becerra said in a statement.

Source: Obamacare Thrown Out by Judge, Raising Insurance Uncertainty – Bloomberg

and:

The President of the American Medical Association claims that prior to the ACA the uninsured rate was 20% (See Addendum-this is not accurate):

“No one wants to go back to the days of 20 percent of the population uninsured and fewer patient protections, but this decision will move us in that direction,” AMA president Barbara L. McAneny said in a statement.

Both statements are propaganda messaging using the methods of

• Fear
• Assertion
• Lying
• What You See Is All There Is

A political figure says the “ruling is an assault on 133 million Americans with preexisting conditions”. That statement is false. A majority of the U.S. population already had pre-existing condition exclusion protections but this is not been well known – because of propaganda messaging that did not want you to know that.

Further, 133 million is 1/3d of the entire U.S. population. This implies that prior to the ACA, 1/3d of the U.S. population was denied health insurance due to pre-existing conditions which is obviously not true. Prior to the ACA, between 14-18% of the population did not have health insurance. The reasons people were uninsured were split almost equally between

1. Were not legal residents,
2. Could afford insurance but voluntarily chose not to buy it,
3. Were children eligible for existing government programs but parents had never signed them up, and
4. Could not afford health insurance or had pre-existing conditions or other limitations.

HIPAA Established Pre-existing Condition Protections in 1996 for Workers

Most people are not aware that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) established protections for pre-existing conditions for those with employer provided health insurance. Here is a direct quote from the American Cancer Society concerning that provision:

Under HIPAA, a group health plan may not impose a pre-existing condition exclusion if the person has had creditable medical coverage for at least 12 months as long as the person had no more than 63 days with no coverage. (Creditable coverage refers to health insurance, and includes most health coverage, such as a group health plan, HMO, individual health insurance policy, Medicaid, or Medicare.) If the coverage was for less than 12 months, the pre-existing exclusion period may be reduced by the number of months of prior creditable coverage.

In other words, most people with existing insurance coverage could not be denied insurance when switching jobs. And for those that may be eligible for a denial, there was a waiting period of up to a maximum of 12 months.

The ACA has a Pre-existing Condition Waiting Period

HIPAA’s solution was not perfect but it is nearly identical to the ACA’s own pre-existing condition waiting period. In spite of what you have heard, the ACA does have a pre-existing condition waiting period. Example: You did not buy insurance at the start of the year. On February you are diagnosed with a disease. Under the ACA, you must wait 11 months until January 1st the next year to purchase health insurance. A waiting period is just another form of pre-existing condition exclusion.

HIPAA Left Out Individuals Not Covered by Employer Provided Insurance; Many States Created Their Own Protections

But HIPAA left out individuals who did not have employer sponsored insurance. Because Federal law did not, in 1996, address this group, about half of U.S. states enacted their own pre-existing condition exclusion laws. For example, I previously lived in a state that extended the concept of HIPAA’s protection to the individual market: if you were already insured, you could not be denied insurance coverage when changing to a new insurance company. Second, if you were not previously insured and had a pre-existing condition, you might be subject to a waiting period of 6, 12 or 18 months before making a claim for the pre-existing condition (only the pre-existing condition – health insurance had no waiting period for other health claims unrelated to the pre-existing condition).

Between HIPAA and State protections, a large portion of the market was already protected from pre-existing condition exclusions. You would not know this, however, due to the propaganda used to market Obamacare. To market Obamacare, the method of fear was used – the fear of having no health insurance due to a pre-existing condition. This marketing propaganda claim continues to this day, as made clear by the California Attorney General’s false claim.

Note – individuals who lived in states that did not enact their own protections, and those who did not have employer sponsored insurance could still be denied coverage for their pre-existing condition. And this is the subset that the ACA’s protections address.

A Majority of the U.S. Population was Protected from Pre-Existing Condition Exclusions

About 38% of the population in the U.S. receives health care provided through government programs: Government employee benefit programs, Medicare, Medicaid, VA benefits and other programs. None of these have pre-existing condition exclusions.

Adding those with employer sponsored insurance, the 38% covered by government programs, and those in states with state-level laws, the overwhelming majority were not subject to pre-existing condition exclusions. Indeed, the California Attorney General makes that clear by separately calling out the 20 million in the individual market, in effect, contradicting himself! His 133 million figure is also contradicted by the AMA’s false “20% uninsured” claim.

The ACA addressed the subset of the market concerning, primarily, the individual market where insurance was not provided by employers or the government.

The Role Played by Propaganda

This post does not argue the merits of these issues or the recent legal ruling but to note how “fear” and “assertion” of a fake fact (133 million or 20% uninsured) are used as propaganda. Politicians lie like this every day and the media let most of them get by with it.

Pre-existing conditions are a problem – but do not have the scope proponents pretended they have. The goal was to create fear, thereby creating political support for their chosen policy. This was a classic example of propaganda messaging that relied on:

• Fear
• Assertion
• Lying
• What You See Is All There Is (no one mentions that the ACA has a pre-existing condition waiting period)

The propaganda campaign by Democrat supporters of the ACA was tremendously successful. Most of the U.S. population believes things about the ACA and health care that are not true. Republicans have consistently failed at propaganda messaging and never addressed the falsehoods promoted by the Democrats. The media has been a failure of doing the job they claim they do, having almost never accurately reported on the issues in the ACA, in large part because they became cheerleaders for the Act, rather than journalists.  If we view journalists as propagandists, then, in fact, they were successful.

We’ve addressed the widespread propaganda messaging used in the ACA promotion in the past.

For the record – I have two pre-existing conditions myself. I have written a 52 page paper on a number of serious defects in the ACA that are surprising – and how they might have been fixed.  A shorter 5 page summary is available here.

To illustrate, here is one problem. In 2018 there is a county where a married 64 year old couple earning $65,000 per year in pre-tax income is ineligible for a subsidy (their income is too high) – but the least cost Silver plan available to them in their market has premiums of $57,000 per year. This makes no sense – how did this occur? The subsidy cut off level is determined by the regional poverty level and has no relation to insurance costs. Consequently, there are many counties in the country where premiums are completely unaffordable, swallowing up most of one’s annual income – but no financial help is available because the cut off level is not connected to the actual insurance cost! That is an example of design defect in the ACA. The ACA contains numerous design defects but the media act like cheerleaders – or perhaps merely ignorant fools – unable to understand the problems. They have never reported on this simple to understand factoid.

Commentary

As my paper explains, there are serious problems in the ACA. The problems are likely fixable (I proposed many solutions in the paper) if there were a political will to fix real problems; but there is not because with politicians the priority is ideology, not solutions. This commentary notes that now would be a good time to fix the problems – but that will not happen as politicians delight in name calling each other rather than solving problems. The Democrats failed to enact legislation that worked and Republicans failed to fix it when they had the opportunity to do so. Now we are stuck with a damaging piece of legislation due to incompetence in Congress.

Addendum

Source

At no time has the uninsured rate been at 20%.

The uninsured rate does not include the non-elderly (65 and over) population because almost everyone in that group is on either Medicare or Medicaid. The overall population uninsured rate is lower than the official number as the official number removes the group that has nearly 100% coverage.