Inpatient Care Reform Proposal 1

According to an article at Health Care Reform.gov, “pre-existing conditions affect millions of Americans”, leaving healthcare unattainable for many of these millions of Americans (5). Congress needs to take action to require insurance companies to accommodate all people with pre-existing conditions. As said by the International Medical Insurance dictionary, pre-existing conditions are defined as “any illness or injury that has manifested symptoms or is known to an individual prior to the start of a policy”. (4) Many insurance companies are currently required to insure people with pre-existing medical conditions, but many do so only with a pre-existing exclusion period, so there is a stretch of time that insurance does not accept claims related to a client’s prior condition. (1) By eliminating these exclusion periods and requiring all insurance companies to insure those people with pre-existing medical conditions, insurance company “cherry-picking” would be more tightly controlled, and insurance companies would cover much more of the currently uninsured population. The Health Insurance Portability and Accountability Act of 1996 (HIPPA) has helped to stop some cherry-picking by preventing discrimination against people with prior medical conditions. The US Department of Labor did a great job explaining how and when HIPPA requires most insurance companies to cover people with pre-existing conditions, but still allows for the varying exclusion period, which can range from six to 18 months (2). Also, under most circumstances, in order to get the “short” exclusion period of six to 18 months, you have to have prior, uninterrupted health insurance, which nearly 50 million Americans unfortunately do not (3). For a cancer or diabetes patient, eighteen months is a very long time to have to cover your own hospital bills.
This reform would undeniably cut down the amount of families that go through medical bankruptcy because more families with diseases and/or conditions requiring frequent medical conditions would be held less accountable for paying for their medical bills out of pocket. Also, access to health insurance would become available to many more people, some which include cancer patients, people with diabetes, and the more and more prevalent problem of patients with high blood pressure. Incorporating this reform into our health care system would better the outcomes of the population because so many more people could receive health care when they need it. This could decrease future health bills because preventative tests/procedures could stabilize the patients’ condition further, leading to less frequent hospital or emergency room visits.
Another current reform is arguing that more money needs to be spent on in-home care rather than long-term care in nursing homes, because long-term care in nursing homes is more expensive for Medicare than in-home care would be. While I feel this is also an important step to consider in our current health care system, I think that we need to focus on getting more people covered by insurance first. If we do not, people with declining health will end up in the nursing homes or in long-term home cares even sooner than they already are, which would cost even more money. People with pre-existing conditions are more likely than healthy people to end up in a long-term care facility anyway, so without getting them health insurance coverage, they will be more at risk to enter into medical bankruptcy, if they can even afford to enter into long-term care at all.
Some people may argue that covering people with pre-existing conditions is not as important as getting the poor and underinsured populations insured. While there may be some relevant points to this, much of the pre-existing conditions population will soon become poor and underinsured, as many of them are already, because insurance will not cover their current medical bills. If we can prevent this from happening, we can keep the poor and/or underinsured population from escalating out of control and once this proposal is put into place, we can turn our attention to the remaining poor/underinsured population.


1. Bihari, MD, Michael. Pre Existing Conditions - Understanding Exclusions and Creditable Coverage. About.com, 8 Feb. 2010. Web. 1 Mar. 2010. http://healthinsurance.about.com/od/healthinsurancebasics/a/preexisting_conditions_overview.htm
2. FAQs About Portability of Health Coverage and HIPPA. United States Department of Labor, n.d. Web. 1 Mar. 2010. .
3. How Pre-Existing Conditions Work. How Stuff Works, 2010. Web. 2 Mar. 2010. .
4. Key Terms and Definitions. International Medical Insurance, 2010. Web. 1 Mar. 2010. .
5. US Department of Health and Human Services. Coverage Denied: How the Current Health Insurance System Leaves Millions Behind. United States Government, 1 Mar. 2010. Web. 1 Mar. 2010. ..