When the Affordable Care Act was passed, on of its central goals was limiting insurance discrimination against patients. People without insurance, usually either poor or sick or both, often couldn’t access care easily—and sometimes not at all. To address this de facto rationing of care, the ACA forbad insurance companies from denying coverage to Americans with pre-existing conditions, and also set annual caps on how much a patient could be required to pay for prescription drugs. But now 300 patient advocacy groups have written have written to HHS Secretary Sylvia Mathews Burwell to denounce the return of “insurance discrimination.” The letter was backed by several big name groups who supported the Affordable Care Act, including the AIDS Institute and the American Lung Association. Here’s the substance of their complaint, from ABC News:
Much of the concern is about coverage for prescription drugs. Also worrisome are the narrow networks of hospitals and doctors that insurers are using to keep premiums down. Healthy people generally shop for lower premiums, while people with health problems look for access to specialists and the best hospitals. […]“People who have high cost health conditions are still having a problem accessing care,” said law professor Timothy Jost of Washington and Lee University in Virginia. “We are in the early stages of trying to figure out what the problems are, and to what extent they are based on insurance company discrimination, or inherent in the structure of the program.”
Insurance companies aren’t the villains here: Faced with very real price pressures, they are trying to manage by restricting access to some doctors and some drugs. But what this story goes to show is just how incomplete a reform the ACA was. Rationing will inevitably be a feature of any health care system, to some extent. However, the more expensive the system as a whole is, the worse rationing becomes. The ACA prioritized expanding coverage over lowering costs, and at the very least has made our health care system no less expensive. Until policy-makers pivot aggressively from expanding coverage in name only to reforms that will make health care cheaper, insurance “discrimination” will always be a bigger problem than it has to be.