About that HHS Report on Pre-Existing Conditions

Is the Department of HHS now reporting to White House political director Patrick Gaspard? It certainly looks that way based on the timely release of a new report today:

As many as 129 million Americans under age 65 have medical problems that are red flags for health insurers, according to an analysis that marks the government’s first attempt to quantify the number of people at risk of being rejected by insurance companies or paying more for coverage.

The secretary of health and human services released the study on Tuesday, hours before the House began considering a Republican bill that would repeal the new law to overhaul the health-care system.

You can read the report for yourself here. What HHS has done is revive the big numbers game that the administration used to push health reform in the first place. Remember how there were 46 million uninsured? Then it was suddenly 30 million in the President’s address before Congress. Now they’ve got an even bigger number to bandy about, 129 million Americans with pre-existing conditions. But pay close attention to how HHS came up with that 129 million figure:

Because pre-existing conditions are determined by insurer practices which vary, two estimates of the number of non-elderly individuals likely to be denied coverage in the individual market were constructed.  The first includes only conditions that were identified using eligibility guidelines from State-run high-risk pools that pre-dated the Affordable Care Act.  These programs generally insure individuals who are rejected by private insurers.  As such, the “lower bound” estimates are people with a health problem likely to lead to a denial or significant mark-up or carve-out of benefits.  The second includes additional common health and mental health conditions (e.g., arthritis, asthma, high cholesterol, hypertension, and obesity) that would result in an automatic denial of coverage, exclusion of the condition, or higher premiums according to major health insurers’ underwriting guidelines identified using internet searches.  Individuals with these conditions would at least get charged a higher premium but could also have benefits carved out or be denied coverage altogether.

So the 129 million Americans figure, which is already appearing in headlines, includes five common maladies which might result in higher premiums. In fact, if you skip down to the methodology section, the dragnet is even broader than that:

Individuals with five common conditions – arthritis, asthma, high cholesterol, hypertension, and obesity (BMI > 35) – were included in the second measure, as were individuals who had “ever been” diagnosed with arthritis, asthma, high cholesterol, or hypertension

In addition, individuals who were currently being treated for neurotic and related disorders, stress and adjustment disorders; conduct disorders; emotional disturbances; and including attention deficit hyperactivity disorder (ADHD) were included in the second measure, as were individuals who had ever been diagnosed with ADHD.

If you’ve ever been diagnosed with a common, treatable illness like hypertension or ADHD (which affects about 4% of American adults), you fit into the broad HHS definition as someone with a pre-existing condition. Again, this is a bald-faced attempt to come up with a big number.

In case you have any remaining doubt that this is a political effort, check out this conclusion:

A central element of the Affordable Care Act, passed by the last Congress and signed into law by the President, is a new set of patient protections that prohibit insurance companies from denying coverage to Americans because they need it…Rescinding the new health insurance protections would, now and starting in 2014: Reduce the health care and health insurance options of the 50 to 129 million Americans with pre-existing conditions…

This is the White House’s latest attempt at messaging on health reform. It’s a little surprising how completely HHS seems to have been turned over to that effort. After all, this report isn’t about carrying out the law as written, which is HHS’ job; it’s about winning a current political debate through a creative use of statistics designed to grab headlines. Is that sort of politicization what we should expect under this administration?