John McCain is getting beaten by a woman, and it’s not Hillary Clinton. It’s Elizabeth Edwards.
In unveiling his health care plan, McCain seems super-focused on the fact that many more people could be denied coverage because of “pre-existing conditions,” as he seeks to shift people from employer-based coverage to the individual insurance market, with some assistance from a tax credit.
Elizabeth Edwards pointedly has challenged McCain, saying that an American with her or his health history would be denied under McCain’s plan in the individual insurance market. (To be fair, the Los Angeles Times made this point earlier.) She’s absolutely right.
And because of this, McCain has a liability. He even has a “myth and facts” section of his website designed to counter exactly one, and only one, myth:
“MYTH: Some Claim That Under John McCain’s Plan, Those With Pre-Existing Conditions Would Be Denied Insurance.
FACT: John McCain Supported The Health Insurance Portability And Accountability Act In 1996 That Took The Important Step Of Providing Some Protection Against Exclusion Of Pre-Existing Conditions.
FACT: Nothing In John McCain’s Plan Changes The Fact That If You Are Employed And Insured You Will Build Protection Against The Cost Of Any Pre-Existing Condition.
FACT: As President, John McCain Would Work With Governors To Find The Solutions Necessary To Ensure Those With Pre-Existing Conditions Are Able To Easily Access Care.”
The multiple “facts” don’t really the answer the charge. The “myth” is a factual statement. Where do those those with “pre-existing conditions” go under the McCain plan? Some will get left behind. In the new twist to the slim pickings already on his website, McCain would now have states figure out how to solve the issue of the “uninsurables.” .The New York Times coverage by Michael Cooper and Kevin Sack focus on this aspect. Bob Laszewski from Health Care Policy and Marketplace Review thinks McCain has opened a major liability for himself.
I think the Democratic rivals made good responses but didn’t quite capture the central critique of this plan in their responses.
* Some of what they say is a criticism of what is *not* in McCain’s plan, which indicates it lacks a certain ambition, but doesn’t really say why the proposal is still not an improvement from the status quo. (Frankly, it doesn’t take much.)
* Clinton appropriately criticizes state high-risk pools (and her statement–“virtually all high-risk pools today have waiting lists, high premiums, and scaled-back benefits”–is a dead-on description for California’s MRMIP, Managed Risk Medical Insurance Program, which now has a waiting list, is underfunded, has high premiums and a $75,000 benefit cap.)
* But in our current system, the state high-risk pools are an essential lifeline to coverage for many. The problem is not the high-risk pool itself, but the major people who are denied in the individual market, that the high-risk pool provides some comfort.
* The real issue is not the high-risk pools in the state as a solution, but that his plan seeeks to make the problem much bigger. The more he accomplishes his goal of moving people from group coverage (like that of their employer) to individual coverage, the more he creates the problem that he seeks to solve.
Here in California, Health Access California supports AB2 (Dymally) and other efforts to improve and better fund our high-risk pool, so more people, denied for pre-existing conditions, can at least get some coverage.
We were more pleased to support AB x1 1, the negotiated reform between the Governor and the Speaker, that included not only guaranteed issue–so no insurers could deny for health status–but it would expanded group coverage enough that there was a net decrease in the number of people having to get individual coverage.
This was important, because the individual market is fundamentally a place where the individual has little market power against the big insurers, as opposed to when they at least have the purchasing power of a group. McCain would place more people in the individual market.
So the criticism isn’t that McCain relies on state-based high-risk pools, it’s that he would increase the need for them in the first place.