In the context of health insurance, a “pre-existing condition” is “Any condition (either physical or mental) including a disability for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on your enrollment date in a health insurance plan”.
Coverage of pre-existing conditions might not be the “untouchable third rail” of American politics – that would be Social Security – but any politician touching it is sure to get zapped.
That includes the Trump Administration, which has tried and tried again to propose new health care legislation.
Why does the argument over pre-existing conditions hurt so bad?
Conflict is typical of nearly any social spending legislation, but it is exacerbated by the immensity of health care expenditures.
It is an immense proportion of all economic activity, cast against the background of an immense Federal debt.
It is an immense proportion of the individual debt for tens of millions of American citizens, with a demonstrated capacity to lead to personal financial ruin.
The difficulties unearthed by pre-existing conditions, as a particular aspect of health care, are more painful still.
To speak of the status of pregnancy is to open up a hornet’s nest of issues that have driven decades of “culture war” conflict in America.
Far from just being about “the bottom line,” the status of pregnancy in health care prods sensitivities concerning gender, religion, ideology, and more.
Again, the language of Health.gov’s definition refers to “Any condition…including a disability.”
But too much of the public, this matter is about disabilities, period: in other words, health events to which we are all prone, but which strike us as special “acts of God” derailing our daily lives and our budgets. Cancer is something meteoric, even to the life-long smoker.
Pregnancy is just a bit special, isn’t it?
Superficially, pregnancy resembles this sort of event. After all, not everyone gets pregnant, and those who do, do so a limited number of times.
But pregnancy has an obvious, special status that sets it apart from an industrial accident or case of the flu.
It is, after all, how we all came into the world. It’s a “condition” upon which the whole future of the human race depends.
Accordingly, it strikes many as odd to consider it a “condition,” pre-existing or not, and downright disturbing to go that step further and associate it with any sort of “disability.”
Rather, pregnancy almost demands to be seen as entirely normal. It is normal even though only a small percentage of humanity is pregnant at any particular moment. It is normal even though a very large percentage of us will never be pregnant.
There can be only one (sex)!
Moreover, pregnancy might be entirely normal, but it is also entirely sex-specific. Women get pregnant and men don’t. This makes it a political football in the ongoing American gender war.
Feminism, collectively, lines up on one side of that war. Social Conservatism, collectively, lines up on the other.
The political parties aligned with each, respectively, find themselves with yet another battlefield.
Regarding pregnancy as a pre-existing condition can look a lot like sexism even before addressing whether that “condition” is to be covered or not.
From the standpoint of feminists, doing so verges upon regarding maleness itself as normal, and femaleness as a sort of aberration. Certainly, this is the sense that gives bite to the article title, “I Am Not A Pre-Existing Condition.”
One can almost hear that title being hissed through clenched teeth. Here we are again, back to those sexist narratives as ancient as Eve being created as God’s afterthought, out of Adam’s rib, for Adam’s pleasure. A woman is not so much herself as simply woe unto man.
As though to show us the practical consequences of these narratives, the author “Jill” gives us the news that “pregnancy itself is often considered a ‘pre-existing condition’ by insurance company (sic), therefore a reason to deny coverage,” as well as similarly sexist restrictions against coverage pertinent to C-sections and domestic violence.
It’s Elephants fighting Donkeys again, oh my!
Predictably, because this is America, all of these facts are politically aligned on the Democratic vs. Republican axis.
It is ten Republicans, then, who voted down a measure making it illegal for insurance companies to deny coverage to domestic violence victims.
It is Republicans who “voted to override regulations requiring insurance companies to cover mammograms in more than 20 states.”
Our object here isn’t to condemn Republicans as sexist, though it might be fair to suggest that between the two parties they seem significantly less burdened by the issue.
The charge of sexism matters because of the current state of health care legislation.
What makes pre-existing conditions a political football is that our current rules were written by a Democratic Administration, and they are seen as being chipped back by a new Republican Administration together with a Republican House and Senate.
What is the GOP thinking?
It isn’t so much that it’s a Republican dogma that pregnancy is a pre-existent condition.
It’s that health care providers have treated it as such, and Republicans are inclined toward giving these providers broad latitude in deciding the matter.
As a CBS News article encapsulates it, the 2017 American Health Care Act (AHCA) proposed by the Republicans “doesn’t specifically refer” to whether a pregnancy is a pre-existent condition, but “would allow insurers, in limited circumstances, to charge people more if they have a pre-existing condition.”
The AHCA, which was eventually defeated, was meant to replace the Affordable Cara Act (ACA, or “Obamacare”).
Prior to the ACA’s passage in 2010, it was a common practice for health insurance companies to deny women coverage because of pregnancy on the grounds that there is certainly a degree of health risk involved in being pregnant.
There are certainly health risks associated with pregnancy. These include Hyperemesis Gravidarum or “morning sickness,” anemia, a greater susceptibility to urinary tract and other infections, hypertension, weight gain, and numerous mental health issues.
These can be dismissed as part of the natural difficulty of bringing human life into the world, but to many health care providers, they are simply risks, to be calculated and charged for like any other.
The inclination of the Republican Party, as the traditional political champion of business interests, is to give the health insurance industry permission to make such decisions.
From the Republican perspective, this isn’t sexism at all, it’s protecting the freedom of private enterprise, arguing that “In too many areas of the economy — especially energy, housing, finance, and healthcare — free enterprise has given way to government control.” Better, they propose, to let those who provide the service the liberty to set the price.
Beyond that, Republicans and conservatives argue that they are protecting the freedom of each state to chart its own, independent course.
They argue, with Senator Bill Cassidy (R, La), that “States should have the right to choose” which form of healthcare is best for them.
This would necessarily include deciding whether pregnancy ought to be considered a pre-existent condition, right states held before ACA’s passage.
Among the more controversial provisions in the GOP alternative to ACA was the “Macarthur Amendment,” named for its sponsor, Rep.
Thomas Macarthur (R, NJ). This amendment would restore the right for insurers to charge customers different premiums, depending upon the presence of pre-existing conditions.
Democrats aren’t buying any of this.
Critics generally dismiss Republican claims that they are simply supporting freedom of enterprise and freedom for the states, pointing to disparities that indicate sexism.
They note the fact that while pregnancy can be regarded as a pre-existing condition, erectile dysfunction – as sex-specific as pregnancy but suffered by men – cannot be so considered.
With pre-existing conditions, maybe the issue isn’t “which” or “who.”
Beyond these broad disagreements lie those which attack the very idea that health insurers should ever be able to deny coverage based on pre-existing conditions at all.
Those holding this position do not argue about whose condition ought to be so defined, or who ought to have the right to define it.
They reject the very notion “that insurance discrimination based on ‘real’ pre-existing conditions is somehow more acceptable.”
They argue that such distinctions simply deny healthcare coverage to the sickest and most vulnerable.
They seem to violate the purpose of healthcare coverage itself. The Kaiser Family Foundation has noted that of all Americans under retirement age, more than one in four has some medical issue which would have left them unable to get health coverage before “Obamacare.”
One in four is not an insignificant portion of the American public. This is not, by any means, “universal coverage.”
It is possible, then, that all the disputation we’ve been embroiled in so far has only been “trimming around the edges” of the real argument.
That fight, as this video shows, looks to be led by America’s disabled, redefining for us all – pregnant or not -what it means to stand up.