The Wonk Room

It’s Time To End Discrimination In Health Insurance»

Insurance companies will seize on anything to increase insurance premiums, and gender is no exception. An article in today’s New York Times points out that insurance companies rate-up individual insurance policies for women, forcing us to pay much more than men for identical coverage.

Since the individual market offers a raw deal to those who actually use care, women — who use maternity care and are more likely to have certain chronic diseases — may have a harder time finding affordable coverage than their male counterparts. A 30-year-old woman pays “31 percent more than a man of the same age in Denver or Chicago” and in Iowa, “a 30-year-old woman pays $49 a month more than a man of the same age.”

But Senator John McCain refuses to end this discrimination. McCain’s plan would make it even easier for insurers to cherry-pick the healthiest individuals who use the least amount of care. When asked why he didn’t support leveling the playing field and preventing insurance companies from covering only the healthiest and cheapest Americans, McCain replied that insurance companies should be able to decide who they cover and what they charge:

Q: Why not level the playing field, prevent insurance companies from cherry picking and let them compete on a level playing field?

MCCAIN: Because then I think then we would be mandating what the free enterprise sytem does and that would be, obviously, something I would not approve of.

Watch the ad from Health Care For America Now!:

I have often argued that buying health insurance is not the same as purchasing a refrigerator or a microwave. Health insurance is not another consumer good for which everyone pays the same price. Sick people are more expensive to insure than healthy people, the old accrue more cost than the young. For this reason, Senator John McCain’s belief in the dysfunctional and discriminatory individual market is fundamentally at odds with the point of health insurance, which requires that we share risks and pool costs.

Insurance companies should not be allowed to use a woman’s ability to become pregnant as an excuse to charge women more for health insurance. Unfortunately, by deregulating the individual market, Senator McCain would give insurance companies a free pass to continue charging women more for their health care.

Elizabeth Edwards On Tony Snow: Let’s Find Common Cause In Stopping This Disease»

This post is reprinted from Newsweek. See the original column here.

Tony Snow has died. A young man (with my next birthday being number sixty, I am entitled to the folly of calling a fifty-three year old “young”), with a facile mind, an easy smile, and a quick wit; a man who had a perpetual twinkle in his eye when he was doing what he he born to do; a man who loved his wife and his children; a man who loved politics and maybe a little more loved the verbal sparring that comes with politics well-played; a man who desperately did not want to die. And when he died, I cried. I know I cried not just for him, but—filled with fear—for myself as well. The diagnoses of our cancer recurrences (”recurrences” being one of those misnomers we simply endure) tumbled out upon one another by days, and I felt—and feel— connected to a man who loved what I loved, although we came to nearly every argument from opposite corners of the ring.

Last week—when Tony was still alive and I was not so afraid—I rode my bicycle in a small Fourth of July parade at the beach to which we have gone for close to two decades. When I got to the celebration and stepped off the bicycle, an older man approached me. I hope you are doing well, he said, and then he added—oddly, it is more often the case that people do feel obliged to confess the gap between us—”although we don’t agree on much of anything.” I thanked him for his good wishes and then I added—as I often do—”and I suspect we agree on more than you think.” He smiled, I smiled, and that was that. And then Tony died. And I thought more about the things on which we agree and the things on which we disagree. And as with my parade companion, I suspect Tony and I agreed on more things that we might have guessed. More »

Elizabeth Edwards On The Inequitable Individual Market»

Our guest blogger is Elizabeth Edwards, a Senior Fellow at the Center for American Progress Action Fund and wife of former Presidential candidate John Edwards.

David Lazarus, in Sunday’s Los Angeles Times, brought us a fresh reminder of the challenges posed by preexisting conditions by raising a new one – being a woman.

Senator John McCain’s health plan is based on the idea that everyone should be on their own to buy their health insurance on the individual market. And it’s an approach fundamentally at odds with the point of health insurance: that we share risks. People with preexisting conditions, like McCain and myself, would pay much more for health insurance under his health plan, if we could get coverage at all.

Insurance companies have all sorts of characteristics they look at in order to increase premiums, such as preexisting conditions, occupation, age, and residence. But I hadn’t realized that the McCain plan would enable insurers to “rate-up” my insurance bill for not only my status as a breast cancer patient, but also my gender.

The ability to become pregnant has long been understood as an excuse to charge women more for health insurance (because, of course, men have nothing to do with that particular health condition). But what makes the Lazarus column interesting is that he tells us that insurers are charging women higher premiums even if pregnancy benefits are excluded. Blue Shield of California (Blue Shield) is now charging woman more in the individual market because:

“Our egghead actuaries crunched the numbers based on all the data we have about healthcare,” explained Tom Epstein, a Blue Shield spokesman. “This is what they found.”

That women get sicker than men?

“It’s all about the statistics,” Epstein said.

That doesn’t really inspire a sense of fairness. Doctors recommend that women have mammograms and other preventative screenings. Is Blue Shield really trying to discourage health screenings? Do they think that women are more accident prone? Whatever their reasoning, one thing is clear – they don’t want to enroll too many women:

“We don’t want to get a disproportionate share of high-risk people,” added Epstein.

As Lazarus noted, “by ‘high risk people,’ what he means is ‘women.’”

Blue Shield, a not-for-profit company, says they are just following the trend of for-profit insurers in California (at least two competitors already adjust premiums based on gender). Blue Shield exists in a competitive market that rewards insurers for doing the wrong things. In that sense, it isn’t fair to pick on Blue Shield in particular, especially since Blue Shield’s CEO speaks constructively on health reform.

The point is that the insurers have given us just another example about how the individual market is fundamentally broken. Embracing it as the solution to our health crisis – as the McCain plan proposes to – will only make matters worse.

Elizabeth Edwards On Health Care: ‘This Is Not A Cheap Shot; It Is Potentially Life And Death’»

Our guest blogger is Elizabeth Edwards, a Senior Fellow at the Center for American Progress Action Fund and wife of former Presidential candidate John Edwards.

John McCain accused me of taking a “cheap shot” on “This Week with George Stephanopoulos” yesterday for noting that people with preexisting conditions, such as he and I have, would not be able to get health care under his plan –- and that he perhaps was not as sensitive to this problem as he should be since he has been in government health care his whole life.

Sen. McCain noted that he was not receiving government health care for the six years he was in captivity. That is true. But it has nothing to do with my point — which is that the problem with Sen. McCain’s health care plan is not how it affects us –- but how it affects the tens of millions of Americans with preexisting conditions who, unlike Sen. McCain and myself, do not have the resources to pay for quality health care.

That is not a cheap shot, it is a potentially life and death question for tens of million of Americans. And it is a question Sen. McCain must address.

McCain’s health care plan is centered around the idea that we’d be better off if more Americans bought health coverage on their own, rather than receiving it through a job or government program. But maybe since he has never purchased insurance in the individual market, he does not know the challenge it presents for Americans with preexisting conditions.

A recent study showed that nearly nine out of every ten people seeking individual coverage on the private insurance market never got it. Insurers will disqualify you for just taking certain medicines because of the possibility of future costs, including common drugs as Lipitor, Zocor, Nexium, and Advair. People who have had cancer are denied coverage and those who get cancer run the risk of simply being dropped by their insurer for any excuse that can be found. And insurers make it a practice to deny coverage to individuals in high risk occupations, such as firefighting, lumber work, telecom installation, and pretty much anything more risky than working in an office.

McCain opposes universal health care because he claims it represents a “big government takeover and mandates.” But yesterday, he said he would help cover people with preexisting conditions by creating a “special Medicaid trust fund.”

A “special Medicaid trust fund”? Talk about a big government takeover. Tens of millions of Americans have preexisting conditions. If he is going to expand Medicaid to cover Americans with preexisting conditions, he is talking about a massive, massive increase in the Medicaid program. He says he opposes more government involvement in health care, but his idea really would be government-run health care.

My questions is: why is he doing this? If he is so concerned about expanding government’s role in health care, why doesn’t he just tell the insurance industry that they have to cover people with preexisting conditions? Why is he more concerned about protecting the insurance industry –- an industry which, by the way, his corporate tax cut plan gives a $1.9 billion tax cut to –- than the tens of millions Americans with preexisting conditions?

McCain’s advisors still can’t say how this special Medicare trust fund will work. I gather we will find that out when Senator McCain gives a speech on health care later this month. Rest assured, I will be paying attention.

UPDATE: Watch the video here.

Elizabeth Edwards Responds: Why Are People Like Me Left Out Of Your Health Care Proposal, Sen. McCain?»

Our guest blogger is Elizabeth Edwards, wife of former Presidential candidate John Edwards.

I freely admit that I am confused about the role of overnight funding in repurchase markets in the collapse of Bear Stearns. What I am not confused about is John McCain’s health care proposal. Apparently Douglas Holtz-Eakin, a senior policy advisor to McCain, thinks I do “not understand the comprehensive nature of the senator’s proposal.” The problem, Douglas, is that, despite fuzzy language and feel-good lines in the Senator’s proposal, I do understand exactly how devastating it will be to people who have the health conditions with which the Senator and I are confronted (melanoma for him, breast cancer for me) but do not have the financial resources we have. In very unconfusing language: they are left outside the clinic doors.

Senator McCain likes to start speeches with a litany of questions that, presumedly, less plain-spoken politicians would refuse to answer. Well, here are some questions he does not ask but, as that plain-spoken politician, he might want to answer:

1. Under your plan, Senator McCain, would any health insurer be required to sell you or me (or those like us with pre-existing conditions) a health insurance policy?

2. You say your plan is going to increase competition to the point that it actually lowers costs. Isn’t there competition today among insurance companies? Haven’t costs continued to go up despite that competition?

3. You say that under your plan everyone is going to pay less for health insurance. Nice words, I admit, but they are words we have heard before. You must know when American families calculate the actual cost of health care, they have to include those deductibles and co-pays and not just the cost of the insurance. Are you talking about cheaper overall or just a cheap policy that doesn’t kick in until after thousands of dollars of deductibles have been paid?

4. Isn’t the type of competition you are talking about really a rush to the bottom? As long as you allow insurers to underwrite and deny access, you encourage insurers to offer plans that may be cheap, but that get that way by avoiding people with cancer or other high-cost diseases or by limiting benefits and treatments, particularly if the treatment is expensive or might be needed for a long time. We all live in the real world; those of us lucky enough to have health insurance have seen how insurers cut coverage and up co-pays or deny particular treatments. The insurance company makes money when it doesn’t have to pay for our health care. (I suspect that if they could, they would write obstetrical-only policies for nuns.) Doesn’t your plan really encourage insurers plans to compete to avoid people with cancer or other high-cost diseases? Don’t you think that the kind of competition that starts with a decent level of required coverage, that doesn’t exclude the care we actually need, would be better?

I am not confused about your reputation: you are the straight-talker, you like to say. This is about health care, Senator McCain. Doesn’t the American voter deserve some straight answers to these questions? As one of those with a pre-existing condition, I sure would like some straight talk.

– Elizabeth Edwards