Losers and winners under medical underwriting

This post is a by-product of my prior post de-gaslighting Betsy McCaughey's ridiculous claim that only 500,000 people would be affected by repeal of the ACA's protections for people with pre-existing conditions seeking insurance in the individual market.   I believe I have a sharpened view of who's been helped and who's been hurt in the post-ACA individual market.

Spoiler alert: in the pre-ACA individual market, more than half of those who needed insurance were either denied coverage, discouraged from applying, offered insurance that excluded coverage for their pre-existing condition, or offered coverage at above-market rates.

McCaughey's argument was built on misrepresenting a 2010 report issued by Henry Waxman and Bart Stupak, then-chairs of the House Energy and Commerce Committee, that drew on data elicited from the four large health insurers in the 2009 individual market , The main takeaways in this study were that coverage denials on the basis of applicants' prior medical history rose rapidly from 2007 to 2009, and that the denial rate reached 15.3% in 2009. That latter figure is roughly at the midpoint between the result of a 2009 AHIP survey of member insurers, which found a denial rate of 12.7%, and the Kaiser Family Foundation's 2013 estimate that 18% of applicants were denied (perhaps the denial rate continued to rise after 2009).

The Waxman-Stupak report  also cited an internal document from one of the insurers articulating a common assumption: that in reality about one third of applicants were effectively shut out of the market, as many were discouraged from applying by brokers, or past experience. The report further noted that one of the four insurers provided 15% of its customers with polices that excluded coverage for their pre-existing condition. While it did not provide an overall estimate for such targeted exclusions, the AHIP survey reports that 6% of coverage offers included such exclusions (and some participating insurers did not report on this question).

What has it got in its pocketses? What's on Stupak's List?

Bart Stupak is a real alpha dog, isn't he? He hangs with those major power brokers the Catholic bishops, and like his puppet masters dismisses the authority of the heads of almost every major order of nuns in the United States:

Congressman Bart Stupak, D-Mich, responded sharply to White House officials touting a letter representing 59,000nuns that was sent to lawmakers urging them to pass the health care bill.

The conservative Democrat dismissed the action by the White House saying, "When I'm drafting right to life language, I don't call up the nuns." He says he instead confers with other groups including "leading bishops, Focus on the Family, and The National Right to Life Committee."

Stupak also maintains that he still has a solid group of 12 House Democrats who will go along with him and vote against the reconciliation package if there isn't a ban on taxpayer-funded abortion.

He met with them Tuesday and said the White House has not successfully peeled off any of them.

The Michigan lawmakers carries the list of the 12 lawmakers allied with him in his pocket, "K Street thinks they know who is on the list. They don't. There are some surprises on there.

Never mind that many of the nuns represented by the letter are on the front lines of this country's broken health care system:

As the heads of major Catholic women’s religious order [sic] in the United States, we represent 59,000 Catholic Sisters in the United States who respond to needs of people in many ways. Among our other ministries we are responsible for running many of our nation’s hospital systems as well as free clinics throughout the country.

We have witnessed firsthand the impact of our national health care crisis, particularly its impact on women, children and people who are poor. We see the toll on families who have delayed seeking care due to a lack of health insurance coverage or lack of funds with which to pay high deductibles and co-pays. We have counseled and prayed with men, women and children who have been denied health care coverage by insurance companies. We have witnessed early and avoidable deaths because of delayed medical treatment.

Never mind too that the nuns find the Senate bill's restrictions on federal abortion funding satisfactory, or that Stupak's longtime Congressional ally Dale Kildee, who spent six years studying for the priesthood, is "convinced that the Senate language maintains the Hyde amendment, which states that no federal money can be used for abortion,” or that Stupak has been caught lying about the Senate bill's adherence to the Hyde Amendment, or that there is strong evidence from Massachusetts and worldwide that expanding health insurance access reduces abortions. 

Stupak has a list in his pocket.  So did Joe McCarthy  -- an entirely fictional one. Stupak does have pro-life colleagues who stood with him when he negotiated his anti-choice amendment to the House bill, some of whom have indicated that they are with him still. But does he have them in his pocket?  If I were a member of the alleged Stupak 12, I'd feel as belittled by him as the nuns were.

Here's hoping that Stupak's political capital proves to be as much sham as his moral capital.

Stupak coalition crack?

Rep. Dale Kildee (D-MI), a key Stupak ally, has stated the obvious: the abortion language in the Senate bill is restrictive enough for any sane pro-lifer (e.g., American nuns), so he will vote for the HCR bill.

For those who know me, I have always respected and cherished the sanctity of human life. I spent six years studying to be a priest and was willing to devote my life to God. I came to Congress two years after the Hyde amendment became law. And I have spent the last 34 years casting votes to protect the lives of the unborn. I have stood up to many in my party to defend the right to life and have made no apologies for doing so. I now find myself disagreeing with some of the people and groups I have spent a lifetime working with. I have listened carefully to both sides, sought counsel from my priest, advice from family, friends and constituents, and I have read the Senate abortion language more than a dozen times.

He added, “I am convinced that the Senate language maintains the Hyde amendment, which states that no federal money can be used for abortion.”

Per Jonathan Bernstein's note about how skillfully Kucinich has played the press in trumpeting his 'yes' vote, I'm a bit mystified why the news of Kildee's decision isn't front-of-blogosphere news.  If the bulk of the Stupak 12 break, it's game over. Kucinich is a party of one. 

Theocracy in America

A lot of people are angry that Senate rules and Republican intransigence give Joe Lieberman and Ben Nelson life-or-death power over the health care reform bill.  I am angry that the Catholic Church also has a near-veto:

Leadership aides say progressives are prepared to take it on the chin and will vote for a final bill without a public option. But they say pro-life Democrats will seek direction from the U.S. Conference of Bishops as to whether they can support an amendment weaker than Rep. Bart Stupak's, thus setting up what will likely be the most difficult negotiation before a final vote.

Catholic bishops have about as much credibility on matters of sexual and reproductive morality as Iranian mullahs have with respect to vote-counting.