Pre-Existing Conditions: Fix Them or Eliminate Them Altogether?

Pre-Existing Conditions: Fix Them or Eliminate Them Altogether?

Healthcare is the single biggest issue affecting voters this election cycle. Understandably, the crown jewel of political debate during the campaigns is the aspect of the ACA that protects consumers from limitations associated with pre-existing conditions.

The ACA, or Obamacare, provided for those in the individual markets to have the same benefits of those participating in group insurance without fear of their past medical history preventing them from participating. The multiple attempts to repeal or change this hotly debated law has caused the issue of pre-existing condition repeal to come to the forefront of the discussions related to healthcare.

Although, this law really only impacts 7% of our population, (those on group plans, Medicare, Medicaid, and VA are unaffected) the discourse is such that most Americans will be impacted. Regardless of the statistics, it is an important issue and must be addressed. Both political parties have established their support for preserving protections for those that have pre-existing conditions. As you would expect, they have very different approaches for how to get there.

Democrats are heavily advocating for a Medicare-for-All legislation that brings healthcare fully under the control of the Federal Government. Republicans on the other hand want to make it mandatory for insurers to provide coverage regardless of medical history. Republicans are less cohesive on this topic, but recognize that this issue is a hot button political issue that must be discussed.

What both groups fail to realize is that mandating the coverage of pre-existing conditions contributes to an increase in premiums and deductibles. The purchase of insurance is essentially a transfer of risk and when you don’t allow the insurance company to make their own determinations on how to conduct underwriting, this will inflate the cost so the insurer can adequately protect themselves against catastrophic losses. Both approaches are attempts to fix the system but there is yet another option that will potentially eliminate the problem of pre-existing conditions altogether.

Health insurance is typically coupled with an employer, and when employees lose their jobs or start their own businesses, they must then go and get their own coverage. If individuals were able to secure the tax benefits enjoyed by employers, individuals would have more freedom of choice to purchase their own benefits that they own. This personal and portable coverage goes with them regardless of employment without fear of denials due to pre-existing conditions. Employers would also benefit under this model by being able to manage and predict their budgets and provide a defined benefit to their employees that would go toward their benefits by way of increased income or funding of a Health Savings Account (HSA). Perhaps Americans would be better served by a legislature that will allow for healthcare freedom as opposed to more regulation and government sponsored solutions.


David has been a professional healthcare executive and a former hospital CEO who specialized in finance and business development.

He received his undergraduate degree in Biology from the University of Houston, and his Masters of Business Administration and Masters of Healthcare Administration from the University of Houston – Clear Lake

David Balat can be reached through his website at Preparing to NOT Be Deplatformed Preparing to NOT Be Deplatformed