How Big is the Pre-existing Condition Problem?

Is it 8,000 or 150 million? Harold Pollack objects to my observation that the former figure appears to be the right one:

Leaving aside that “150 million or more” number, I’m puzzled that Goodman would take low initial enrollment as a sign that problems of the medically uninsured were “hyped and exaggerated from the get go.”

My own work and the work of others documents that a significant number of Americans face the dual challenge of uninsurance and serious illness. For example, data from the 2005-2006 National Health and Nutrition Examination Survey (the most recent complete data available when this research was done) indicate that 440,000 uninsured Americans have been diagnosed with strokes. Almost 1.3 million have a history of cancer. More than 500,000 were diagnosed with congestive heart failure. In many cases, such conditions pose obvious obstacles to obtaining affordable health insurance coverage.

Megan McArdle comes to my defense:

We’re talking about a program that was supposed to serve almost 400,000 people, and is instead serving around 2% of that number. Nor have these people been turned away due to budget constraints; they don’t seem to have applied in the first place. This leads us to one of two conclusions:

  1. Pollack’s study, and others like them, have massively overestimated the population of patients who would like to purchase insurance at market rates, but cannot do so due to their pre-existing conditions; most people with pre-existing conditions who needed coverage were managing to find it one way or another under the old system.
  2. There are huge numbers of people out there who cannot access critical services, yet for some reason, they have not been able to negotiate their way into the new program.

If the former is true, I think you have to acknowledge that Goodman is at least partially right:  we just passed a massive new health care entitlement in large part based on appeals to the plight of people who do not exist–at least, not in anything like the numbers that we were told. If the latter is true, then shouldn’t HHS be stepping up their efforts to get folks enrolled in the program?

Comments (14)

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  1. Liz says:

    Over at Investors Business Daily, David Hogberg makes some excellent points about who and how many have really been denied coverage. And, he also cites John Goodman:

  2. Joe Barnett says:

    Having a pre-existing condition is not the same as being uninsurable.

    What the new law will do is create more uninsurable people. How? By not allowing any risk adjustment and no high deductible ($10K threshold) plans. By making health insurance more unaffordable to more people, the new law will create more uninsurable people. But they won’t be able to afford insurance in the risk pool either — so until it is provided free by net taxpayers, they will remain uninsured.

  3. Brian Williams. says:

    Supporters of Obamacare claim that 34 million uninsured people now have health insurance because of the PPACA. Suspending reality for a moment, now they say that 150 million people with pre-existing conditions will lose their insurance if we repeal Obamacare.

  4. Devon Herrick says:

    High medical spenders tend to be older individuals. Annual medical spending, on average, doesn’t surpass $3,000 until about age 50. Indeed, 80% of the population spends less than $3,221 on medical care annually. Claiming that 129 million people have pre-existing conditions is a stretch designed to make more people feel like they have a reason to support regulations.

    Some articles I’ve read suggest more people would join the high-risk pools if the premiums weren’t so high. One person complained his premiums would be $600 – similar to his rent. Basically, when faced with high premiums, many people with pre-existing do the math and realize they can always pay out of pocket until their care costs are more than the premiums. Then they can sign up.

  5. Harold Pollack says:

    I will respond more carefully at a later date. I will just say now that the low initial enrollment for PCIP does not imply that the number of medically uninsured is anywhere near this 8000 figure. To make an analogy, the HAMP program has helped a small number of financially strapped homeowners. That doesn’t mean that the foreclosure problem is overblown.

    Readers of my piece will see that I believe about 4 million uninsured people have serious health problems that meet commonsense definitions of the medically uninsured.

  6. Jeff says:

    All I can say is the obvious: if I had a serious health problem and could get an insurance company to pay for my care by paying a premium no higher than what healthy people pay, I would do it in a heart beat.

  7. Bruce says:

    I’m with Jeff and with Megan. The argument Harold Pollack is making doesn’t make sense.

  8. Paul H. says:

    This is a good debate to have. Untill this year, all we heard was anecdotes. Now the burden of proof is on Pollack and others. They need to put up or shut up.

  9. Virginia says:

    In my opinion, most insurance companies would regard being alive as a preexisting condition.

  10. Len says:

    I agree with Paul. Let the pro Obama Care folks put up or shut up.

  11. Joe S. says:

    You would think that if someone has a serious health problem and can’t afford to pay the premium that even a healthy person would pay, the providers would pay the premium for them.

  12. Erik says:

    This is the same argument as “How many people are actually unemployment?”

    Is the definition limited to only those “unemployed but receiving benefits and still looking?” or “Those unemployed not receiving benefits and still looking?” or “Those unemployed and not looking?” or “Those underemployed?” or a combination of all subsets.

    This is a case of (political) lies, dam lies, and statistics.

  13. Greg says:

    How big is the problem? Not nearly as big as the left says it is.

  14. Chris says:

    “All I can say is the obvious: if I had a serious health problem and could get an insurance company to pay for my care by paying a premium no higher than what healthy people pay, I would do it in a heart beat.”

    And of course, such a plan wouldn’t really be “insurance” but a sort of “market adjusted pre-payment plan” with you the “insured” only paying some of the payments.