RUTHFULLY YOURS

If you’ve only followed coverage of the Republican health-care bill loosely in the media, you might believe that House Republicans, after much effort, passed legislation to deny people with pre-existing conditions health insurance.

The issue of pre-existing conditions has dominated the debate over the GOP health-care bill out of all proportion to the relatively modest provision in the legislation, which is being distorted — often willfully, sometimes ignorantly — into a threat to all that is good and true in America.

The perversity of it all is that the legislation is properly understood as doing more to preserve the Obamacare regulation on pre-existing conditions than to undermine it. The legislation maintains a federal baseline of protection in such cases, and says only that states can apply for a waiver from it, provided that they abide by certain conditions meant to ensure that no one is left out in the cold.

Since these provisions only involve the individual insurance market, a small slice of the overall insurance picture (about 18 million are on the individual market), and merely make possible state waivers, they are inherently limited.

You’re not affected if you get insurance through your employer (155 million people), or through Medicaid or Medicare. You’re not affected if you live in a state that doesn’t request the waiver, a category that will certainly include every blue state and most red states, too. Even if you buy insurance on the individual market and live in a state that gets a waiver, you’re not affected if you’ve maintained insurance coverage continuously and not had a gap in coverage longer than 63 days.

By this point, we’re talking about a fraction of a fraction of a fraction of the population. If you do have a pre-existing condition in a waiver state and haven’t had continuous coverage, you can be charged more by your insurer only the first year. The state will have access to $8 billion in federal funds explicitly to ease the cost of your insurance, and the state must further have a high-risk pool or similar program to mitigate insurance costs for the sick.

Clearly, if Republicans set out to recklessly endanger the well-being of people with pre-existing conditions, they didn’t do a very good job of it. The purpose of these provisions isn’t to punish people who are sick, but to create an incentive for people to buy insurance while they are healthy. (The Obamacare exchanges are failing because the law’s tangle of regulations drove up costs and made insurance economically unappealing to the young and healthy.)

The purpose of these provisions isn’t to punish people who are sick, but to create an incentive for people to buy insurance while they are healthy.

It takes all of five minutes to understand the basic architecture of the House bill on pre-existing conditions, yet it has been subject to wildly ill-informed and deceptive attacks. Nancy Pelosi called the provisions on pre-existing conditions “deadly.” Representative Frank Pallone of New Jersey said the bill would hurt 129 million people with pre-existing conditions, starting from an exaggerated figure and then assuming every single one of them would be harmed by the House bill.

Such is the hysteria around this issue that using the phrase “pre-existing condition” has become a license for making any charge whatsoever. Feminists have spread word that the bill treats rape as a pre-existing condition, a stupid lie that has been treated seriously in cable TV debate. As the Washington Post Fact Checker noted, not only does the bill not classify rape or sexual assault as a pre-existing condition, almost all states have their own protections for victims of domestic violence and sexual abuse.

There are certainly legitimate criticisms to be made of the House bill, and ample room for the Senate to improve it, especially by boosting its coverage numbers. But it is not an act of heedless cruelty against the sick. As for its critics, their reflex to demagogic dishonesty isn’t a pre-existing condition, just an ingrained habit.