Opinion: What the White House Left Out of Its 'Pre-Existing Conditions' Report

A report that says nearly half of all non-elderly Americans are at risk of losing their health insurance coverage thanks to a pre-existing condition is enough to get anyone's attention -- even when it's part of a White House political campaign to undermine the Republicans' health care reform repeal effort.

But that's the finding of an analysis from the Department of Health and Human Services, which concludes that "129 million people could be denied affordable coverage without health reform." That's because, the report says, between 50 million and 129 million non-elderly Americans have a pre-existing health care problem that could lead to outright denial of insurance coverage.

The result: "Workers with a pre-existing condition may be less able to change jobs for fear of losing that coverage."

The reform law will protect these at-risk folks, the analysis says, by forbidding insurance companies from denying coverage to people with pre-existing conditions or charging them exorbitant premiums.

The only problem is that the report left out a few facts that tend to undermine the scary headline.

The first of which is this: Most people get coverage from employer-provided health plans and are already protected from coverage denials based on pre-existing conditions.

One protection came in the form of the 1996 Health Insurance Portability and Accountability Act. As the Department of Labor notes, "in the past, some employers' group health plans limited, or even denied, coverage if a new employee had such a condition before enrolling in the plan." Under HIPAA, it says, "that is not allowed."

When he signed the bill into law, President Bill Clinton said that HIPAA "seals the cracks that swallow as many as 25 million Americans who can't get insurance or who fear they'll lose it. Now they're going to be protected." (To be sure, the law does still allow a limited exclusion of coverage for pre-existing conditions for at most 12 months.)

In addition, every state in the country has "guaranteed issue" laws for small group health plans -- health plans that cover as few as two people (or one person, as is the case in nearly a dozen states), as well as pre-existing condition rules for these plans that meet or exceed federal law, according to the Kaiser Family Foundation.

As a result, the vast bulk of the privately insured get coverage through employer or group plans subject to these pre-existing condition protections, with just 14 percent buying insurance on their own, as the chart below (based on data from the Census Bureau) shows.

Still, that does represent tens of million of people with health problems exposed and does make it harder for anyone with a health condition who wants to strike out on their own to get health insurance.

But even here there may at least be some protection available -- in the form of state-run high-risk pools that aim to provide backstop coverage for those denied insurance because of a pre-existing health problem. Thirty-four states offer this protection, and the health reform law provides funds to make these more affordable as a stop-gap measure before the main insurance market reforms start in 2014.

And this is to say nothing of the nearly 60 million who get coverage through Medicaid or through military benefits -- neither of which can deny coverage based on health status.

So, while it may be true that half of non-elderly Americans have a health problem that could -- if they weren't getting coverage from their employers, Medicaid, the military or state-run high-risk pools -- lead them to be denied insurance, most don't and likely never will fall into that category.

This is not to say there isn't a problem with denial of coverage, sky-high premiums, carve-outs, lifetime spending caps and various other insurance industry money-saving tricks that can wreak havoc on the budgets on the sick in this country.

But it doesn't do anyone any good to exaggerate the scale of the problem, or paper over the many protections that have already been put in place for those suffering with pre-existing health problems, just to create a scary headline.