People with pre-existing conditions should be able to get health insurance. Pre-existing condition clauses exclude people from receiving care or insurance if they have had a history of disease, ailments, or health risks while they were not insured by a qualified insurance plan. There need to be health care options for these people. That is not negotiable. Leaving them out of the only safety net available is not an option we should accept. However, is the only alternative eliminating all pre-existing condition clauses? No, it isn’t.

The plan proposed by the President, and both the Senate & House bills, require that all pre-existing condition provisions be stricken from every single health care plan. What does this translate into for you and me? It translates into everyone having to pay a lot more for their health coverage because of the automatic risk assumption the insurance carriers will have to assume and the lack of products competing in the market. If we are trying to lower costs in health care, creating one product for all is not the direction to go in. One product means no competition, guaranteed price increases, and no market forces in this area to bring additional value.

What are the alternatives? As with most things, the alternatives lie in widening the field of options.

As with any insurance, there must be an underwriting process to determine if the insurance provider will assume the liability of insuring any particular person. The insurer deserves to know what kind of health the person is in they are being asked to insure. It is only right and fair to do so.

Option 1

With life insurance, as opposed to personal health insurance, there is often a guaranteed issue amount. A guarantee issue is an amount of life insurance a person is guaranteed to be approved for – regardless of any other factor. The amount beyond that is dependent on underwriting approval. Could health insurance not do the same thing? Could an insurer offer certain kinds of coverage (e.g., physicals, primary care doctor visits, emergency room care, certain kinds of treatments, etc.) as a guaranteed issue and offer additional levels of coverage pending underwriting? Even if denied additional levels of coverage, a person could still receive a majority of their needed care through this kind of process.

Option 2

Another kind of health care product could be a plan that does eliminate all pre-existing conditions with no underwriting. Surely the cost of this product would be higher than had they undergone the underwriting process. Nevertheless, this would allow those who need or desire to bypass underwriting to receive all the care they need.

Option 3

A final kind of health care option would be where underwriting is involved but if an individual does have a history of certain kinds of disease or ailment, their private plan is approved at the higher coverage but at a rate that factors in the person's history and likely needs.

For options one and two, there could be an increased tax deduction based on health care premiums for those who would have these kinds of plans. This additional tax relief would help offset for the increased premium.

Are there other alternatives to these three options? Of course there are. This is just the beginning. However, these three options provide for all, both those with pre-existing conditions and those without, to receive the kind of medical care they need and at prices that reflect the level of service they are likely to use. This kind of adjustment would greatly expand coverage options for those in our country who need it most.

This approach also preserves the market’s ability to provide alternatives and a variety of different products. This is a fundamental element to expanding coverage and lowering cost. A one-size-fits-all approach could never do that. Freedom and Justice in health care is the answer to true health care reform.