Politics

Wednesday Hearing Could Rob Cancer Patients of Coverage, Why Not Just Target Smokers?

Wednesday Hearing On Preexisting Conditions Could Rob Cancer Patients of Coverage

Oral arguments Wednesday before federal judge Reed O’Connor of Texas – who has previously ruled against Obamacare on other grounds – could result in an invalidation of the entire Affordable Care Act [ACA, also known as Obamacare], including the provision which prohibits discrimination against persons because of preexisting conditions such as cancer.

Preexisting Conditions Smoking While Walking
vborodinova / Pixabay

Apparently because this is the most popular provision of the ACA, almost a dozen senators have introduced the “Ensuring Coverage for Patients with Pre-Existing Conditions Act,” hoping to assure voters with cancer and many other preexisting conditions that the ACA’s protection will remain in place even if the ACA is invalidated by the courts or overturned by Congress.

But, warns public interest law professor John Banzhaf, the bill would provide only fig leaf coverage since, while companies under the bill could not refuse to insure patients with existing conditions such as cancer, they could refuse to fund treatment for such preexisting conditions and/or charge patients with a history of such diseases a huge surcharge.

Fortunately, a much better and fairer way of dealing with a major part of the preexisting conditions problem already exists under Obamacare, and repeal or invalidation of the ACA would make it even better and stronger, argues Banzhaf.

According to the National Cancer Institute, lung cancer kills more Americans each year [154,050] than any other form of cancer – more than twice that of the next leading form of cancer – and the costs of treating this leading cancer are correspondingly huge.

Moreover, most lung cancers are caused by smoking, an activity only a tiny fraction of Americans (about 15% of adults) indulge in, yet the huge health care and other costs are shared by all Americans in the form of high taxes (to treat smoking-caused diseases under Medicare, Medicaid, and many other programs) as well as needlessly inflated health insurance premiums.

Indeed, the American Lung Association estimates that smoking costs the American economy over $300 billion a year (including over $115 billion in direct health care expenses alone), and a court, after hearing all the evidence under oath and subject to cross examination, concluded that each smoking worker can cost his employer over $12,000 (in 2018 dollars) per year.

Recognizing this, and that many health insurance companies had already been charging smokers more for their health insurance – as they do, for example, with life insurance – the ACA authorized companies to impose a 50% surcharge on smokers; an additional charge which would cover only a fraction of the additional costs their smoking adds to the insurer’s liability.

If the ACA rule on preexisting conditions is ended by legislative or judicial action, this provision would also end, so the law regarding surcharges for smoking would revert to the law which existed prior to the passage of the ACA, says Banzhaf.

But, as a result of two different rulings which Prof. Banzhaf obtained in 1987, and then reaffirmed in 2004, insurance companies were authorized to charge smokers a surcharge on health insurance of any amount – or at least by any amount which could justified by actuarial statistics.

Forcing smokers to pay more of their fair share of the huge costs their habit imposes on the nation’s health care system is fairer than forcing the overwhelming majority of taxpayers who are not smokers to shoulder these costs.

It is also much fairer and more humane to force them to pay for the cancer and other diseases their smoking causes now, when they can still quit and avoid the deadly disease and the entire surcharge, than denying them coverage after their deadly lung cancer has been detected and it is too late.

This would impose, for the first time, widespread personal responsibility for individual health-related decisions, which is something both Republicans and Democrats insisted was necessary to slow ever escalating health-care costs, rather than the ACA approach on preexisting conditions  which largely simply shifts the costs from one population group to others.

We do know from many studies that even small incremental increases in the cost of being a smoker – e.g., small hikes in the per-pack tax on cigarettes – clearly have a significant impact on helping the overwhelming majority of smokers who want to quit to do so.

Thus it is reasonable to believe that a multi-thousand-dollar surcharge on yearly insurance premiums, even if broken up into monthly or bi-monthly payments, will have an even bigger impact – especially since smokers will see the figure all at once, rather than spread out over time as they do for a typical one-pack or two-pack a day smoker.

Indeed, the Wall Street Journal and the British Medical Journal have reported that imposing a smoker surcharge can slash smoking rates among employees by 50%.

So, at least with regard to lung cancers, imposing surcharges on smokers before they contract lung cancer is far preferable, and certainly fairer, than denying or limiting their coverage once their preexisting conditions become reality.