Words matter. Language is important in communicating ideas and positions. It is critical to use clear, concise language to convey exact meanings and avoid misunderstandings and confusion. Utilizing terms that were crafted by those who oppose one’s position help to undermine one’s position or argument. To that end, I propose we stop using the term ‘pre-existing conditions’ immediately.
In many other countries, previous diagnoses and health issues, chronic conditions, and injuries are simply referred to as an individual's medical history.
We seem to have accepted the concept that a 'pre-existing condition' is a perfectly reasonable and normal reason for someone to be denied health insurance coverage. Even though the ACA actually outlawed insurance companies from using PECs to deny insurance in qualified plans under the law, we have allowed ourselves to be convinced that being sick or injured is a justifiable reason for not being eligible for health insurance in the future. This is fundamentally wrong, and it must stop.
The term pre-existing condition was created by the U.S. insurance industry to identify conditions and diagnoses that would allow them to exclude insurance coverage for individuals who had purchased health insurance. This was done with the ultimate goal of realizing greater and greater profits for insurance companies, their executives, and their shareholders.
There is no comprehensive industry-wide list of PECs. Each insurance company has their own internal list. These lists change and have even been expanded when consumers, who had faithfully paid their monthly premiums, became ill. There have been documented cases where consumers received a diagnosis or experienced a critical accident and the insurance company would work to find anything, no matter how specious, that would allow them to exclude coverage for that individual retroactively - coverage that individual had paid for in good faith, and leaving the individual on the hook for sometimes hundreds of thousands of dollars.
In addition, PECs are used by short-term and so-called unqualified plans under the ACA - those that still require underwriting - to preclude medical conditions from coverage, up to and including gender. One case documented in the past year noted a young woman who had experienced incredibly heavy menstrual cycles. One month, she hemorrhaged and needed surgery and several blood infusions to save her life. The short-term insurance company declared that simply being a woman, and therefore subject to potential complications from menstruation, was a pre-existing condition and denied coverage for any of her treatment.
There is a significant difference between so-called PECs, which again are a wide category of insurance company-identified reasons for declining insurance coverage, and chronic medical conditions. Unfortunately, over the last couple of years, they have come to mean the same thing, or be used interchangeably. Many PECs have nothing to do with chronic medical conditions. A broken ankle is not the same as arthritis or multiple sclerosis.
Further, the fear of having a potential PEC become part of a one’s medical history has led some people to avoid or delay medical treatment. In case the ACA protections are stripped away and we lose them altogether, some people are delaying treatment until their care can no longer be ignored for fear of having a diagnosis on their medical record that could be used to deny future insurance coverage. These delays frequently result in much higher costs than if they had been treated earlier.
The longer we continue to use the expression PEC, or ‘pre-existing condition,’ the longer we are allowing the health insurance industry in this country -- a for-profit industry focused on their bottom line and keeping their shareholders and Wall Street happy -- to dictate the discussion. It is time to simply stop using their terminology. It is time to stop letting them dictate what constitutes comprehensive medical care and coverage.
It is past time for us to retake the narrative, and begin working for a comprehensive, equitable, affordable, quality, universal health care system on our own terms - for the benefit of the people.
It is past time to simply state that we are all more than our medical history.
It is past time to declare that our health is no one’s commodity.
It is past time that we agreed that every single person deserves quality affordable care based on the concept of humanity and decency, and on the core precepts of our country - that all are created equal and all are endowed with the unalienable rights of life, liberty and the pursuit of happiness, which includes universal, affordable, comprehensive, equitable, quality health care.
It is past time we stopped calling our medical history ‘pre-existing conditions.’
5/20/2019 05:21:50 pm
Great post! Made me think about an important issue that escaped my consciousness. PEC is simply a device employed by the insurance companies to deny coverage to any individual or group whose health needs threaten to any degree their drive for maximal profits. More important is the ideological conditioning ("brainwashing") conducted by the insurance industry, the mainstream media, and the government that leads the general public to unwittingly accept this horrific subterfuge.
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ACA Consumer Advocacy
This blog contains thoughts and observations about health care and the ACA in the United States.