Access to health insurance regardless of medical condition under fire

June 13--Dr. Rodney Snead's prognosis for Anniston isn't good, if residents lose their health insurance access because of pre-existing medical conditions.

As a physician practicing in the city for more than 30 years, Snead has seen the area's high rates of diabetes, heart disease, cancer and other health issues. If a recent federal decision to end the guaranteed access to health insurance despite pre-existing conditions is upheld, area health outcomes would likely get even worse, Snead said.

"It would definitely impact the area," Snead said. "People wouldn't go to get care because of the cost and then patient care would continue to deteriorate."

Last week the U.S. Department of Justice announced that it would no longer defend the pre-existing conditions provision of the Affordable Care Act, the federal health care law known as Obamacare. Some health care experts say that ending the provision could lead to poorer health for some residents and higher overall health care costs.

Through the announcement, the department effectively sided with Texas and 19 other states, including Alabama, which are suing to strike down the entire health care law.

If the lawsuit succeeds in the coming months, insurers could again deny coverage based on pre-existing conditions like before the ACA provision started in 2014.

In the short term at least, many Alabamians shouldn't see any changes to their coverage because of the Justice Department's decision.

Blue Cross and Blue Shield of Alabama, the single largest private insurer in Alabama, plans no changes its policies, said Koko Mackin, spokeswoman for Blue Cross.

"Our current plans are to continue offering ACA-compliant plans on and off the federal exchange," Mackin said.

Blue Cross is the sole provider of the state's ACA health insurance plans, which are tax-subsidized for residents who'd otherwise be unable to afford them.

Karen Pollitz, senior fellow adviser for the Kaiser Family Foundation, a nonprofit, nonpartisan group that focuses on health care issues facing the country, said the end of the provision would mainly affect Americans who buy insurance through the individual marketplace. Depending on their pre-existing conditions, a person might see higher premiums than before or be denied coverage all together, Pollitz said.

"They might just go without coverage or they might get it if they can afford it," she said. "Or they might decide not to retire or quit their job to start a business because they'd lose their employer insurance and would be unable to buy coverage on their own."

If private insurers return to their practices before the ACA began, that could affect a sizable number of Alabamians, said Dr. David Becker, associate professor of health care organization and policy in the University of Alabama at Birmingham's school of public health.

"There's a large faction of the population that does have pre-existing conditions," Becker said. "There are large parts of the population with overall bad health."

According to a 2016 study by Kaiser, there were an estimated 52 million Americans with deniable, pre-existing conditions, such as diabetes and cancer.

And if more residents start holding off on getting care because they can't afford insurance, that could raise health care costs, Snead said.

"People would wait until they absolutely had to go to get care and that would mean more uncompensated care at hospitals," Snead said. "I think the overall cost of health care would go up."

Donald Williamson, CEO of the Alabama Hospital Association, said some residents and hospitals could see higher costs if the ACA provision ended.

"Anything that undermines the insurance market could cause premiums to go up, meaning a rise in uninsured because fewer people could afford the rates," Williamson said. "If you increase the uninsured, that puts further stress on hospitals already struggling with substantial portions of uncompensated care."

Glenn Sisk, CEO of Coosa Valley Medical Center in Sylacauga, said an increase in people losing their coverage would make matters even worse for hospitals in Alabama. Sisk said Alabama hospitals, particularly rural ones like his, already care for sizable numbers of uninsured patients because the state refused to expand Medicaid.

The ACA offered billions of dollars to states several years ago to expand their Medicaid programs. Alabama was one of several states that didn't accept the money.

Medicaid is a joint state-and-federal program that provides health care coverage to 1 million of the state's poorest, mainly children and the disabled.

"We continue to see a fairly steady flow of uninsured, and obviously if Medicaid expanded, we'd see a decrease in uninsured patients," Sisk said. "Medicaid expansion would have been a lifeline for hospitals."

Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.

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