Obama and McCain On Coverage of Pre-Existing Conditions

Several organizations and publications have evaluated the health care plans proposed by John McCain and Barack Obama recently.

In its November 2008 issue, Consumer Reports compared the two based on real-life needs. One scenario presented the case of 59-year-old Susan Braig, a self-employed artist and grant writer who was diagnosed with breast cancer in 2004. Her current insurance costs only $2,496 a year, but when she was sick, it did not cover chemo and other out patient treatments, leaving her $40,000 in debt. Consumer Reports looks at how McCain and Obama would cover her and offers this bottom line:

Obama would probably do more to cut costs and improve coverage for those like Braig with limited income or a poor health history.   Among other things, he’d prohibit insurers in the individual and small-business market from selling plans with coverage with loopholes like those in Braig’s plan.

In a comparison chart, the magazine looks at the “Ability to get coverage regardless of a pre-existing condition” and says:

MCCAIN: In McCain’s deregulated market, insurers could choose whether or not to cover pre-existing conditions, so rules would vary from policy to policy. People with health issues could instead apply for coverage under a federal-state GAP plan. The campaign promises GAP insurance will be comprehensive and affordable but has offered few details. Existing high-risk pools tend to be costly.

OBAMA: Obama would explicitly require insurers to cover pre-existing conditions. The campaign says those policies would be affordable, since its plan would make the health system more efficient and cut $2500 yearly from the average family’s bill. It offers no specific calculations to support that number, however, and others say costs would go up since more sick people would be covered.

Mary Carmichael, in Newsweek’s October 6 issue, asked Katherine Swartz, a professor of health policy and economics at Harvard, to compare the two programs. An excerpt:

Can you explain McCain's plan to help out people with previously existing conditions by expanding "high-risk pools"? 
We've had state-sponsored high-risk pools for several decades, but they cover fewer than 200,000 people. They were set up so insurance companies could essentially cede people who they predicted would have very high health-care costs. At one point McCain said he would subsidize high-risk pools with between $7 billion and $10 billion a year. That would cover maybe 3 million people, which is not much of a dent in the 47 million people without insurance now.

Obama would also require insurers to cover people with pre-existing conditions. Wouldn ' t insurers raise premiums?
Yes, premiums may be higher. I think people need to consider the alternative—if patients are closed off from coverage, they still go to the ER, and we all pay for that.

The Kaiser Family Foundation gives a side-by-side comparison of the two candidates’ plans. It doesn’t provide a specific category on pre-existing conditions, so it says nothing about McCain’s plan in that respect, saying only that Obama would “Prohibit insurers from denying coverage based on pre-existing conditions.”