Cornyn Endorses McCain’s Plan, Confused About Pre-Existing Conditions In Individual Insurance Market

During an interview with the Dallas Morning News, Sen. John Cornyn (R-TX) endorsed Sen. John McCain’s (R-AZ) health care proposal and suggested that Americans with pre-existing conditions could find coverage in the individual market:

Q. Do you support Senator McCain’s — and President Bush”s — proposal to move away from employer sponsored [health] insurance and not just have those tax credits focused — tax breaks — on big employers?

A. I do because, you know, one thing that I’ve been amazed at is how many people feel like they’re trapped in a job that they don’t like because they’re afraid to move to a new job and be excluded under a pre-existing conditions clause in their new employer’s health insurance policy.

Cornyn has it backwards. While the Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes protections “that limit exclusions for preexisting conditions” for individuals in groups plans, the unregulated individual insurance market systematically excludes people with pre-existing conditions from coverage.


In fact, if individuals enroll in “their new employer’s health insurance policy,” when “first eligible” they would not be “subjected to the 12-month preexisting condition exclusions period”:

Under HIPAA, the only preexisting conditions that may be excluded under a preexisting condition exclusion are those for which medical advise, diagnosis, care or treatment was recommended or received within the 6-month period before your enrollment date… If you had a medical condition in the past, but have not received any medical advise, diagnosis, care or treatment within the 6 months prior to your enrollment date in the plan, your old condition is not a preexisting condition to which an exclusion can be applied.

Conversely, Americans with pre-existing conditions can rarely find coverage in the individual market. According to one Commonwealth study, nearly 90 percent of people seeking coverage in the individual market “never end up buying a plan, finding it either very difficult or impossible to find one that met their needs or is affordable.” Individuals with preexisting conditions are “denied coverage, have conditions excluded, or face much higher and often unaffordable premiums.”

Last month, Cornyn claimed that the Texas health care system — despite having the highest uninsured rate in the country — should serve as a model of reform. Thus if Cornyn sees a high number of uninsured as a marker of successful reform, then McCain’s plan — which would increase the number of uninsured Americans from 45.7 to 55 million by 2013 — is certainly his best option.