Health Care, ‘Pre-existing Conditions,’ In Spotlight

about almost anything, and his answer sidles over to "pre-existing conditions."

Why did he vote to preserve the Affordable Care Act? To protect people with pre-existing conditions.

Why did he vote against the GOP-backed tax reform package? Because it repealed the ACA's individual mandate to purchase insurance, which exposed it to a lawsuit filed later against it, which targets people with pre-existing conditions.

Why did he vote to confirm Justice Brett Kavanaugh to the Supreme Court after women lodged multiple allegations of sexual assault against him? Along with stating he did not have enough evidence to corroborate the claims - Kavanaugh will consider people with pre-existing conditions.

"With respect to any cases that may come before him impacting the 800,000 West Virginians with pre-existing conditions, Judge Kavanaugh assured me personally that he would consider the human impacts and approach any decision with surgical precision to avoid unintended consequences," Manchin said.

Since the implementation of the ACA, commonly known as Obamacare, insurance providers cannot deny coverage to people with pre-existing health conditions, and cannot charge them higher rates than those without.

Manchin, who is running for re-election against state Attorney General Patrick Morrisey, has leaned into the ACA over the past few months of his campaign. His language often tilts toward protections for people with pre-existing conditions - a massive chunk of the state's population.

In West Virginia, about 392,000 non-elderly adults have pre-existing conditions, according to the nonpartisan Kaiser Family Foundation, although other sources offer higher estimates. By KFF's count, 36 percent of non-elderly West Virginians have a pre-existing condition, compared to 27 percent nationally.

With the ACA came the expansion of Medicaid to 138 percent of the federal poverty level. In West Virginia, about 543,000 people receive health insurance through Medicaid or the Children's Health Insurance Program, including about 160,000 who qualify through that Medicaid expansion.

The Medicaid dependence goes even deeper in poorer pockets of the state. Of McDowell County's 18,500 residents, about 10,000 - or 54 percent - receive health care through Medicaid, according to data from the state Department of Health and Human Resources.

According to U.S. Census data, 19 percent of West Virginians are 65 and older, compared to 15 percent nationally; 14 percent of West Virginians under the age of 65 have a disability, compared to 9 percent nationally; and 19 percent of people live in poverty, compared to 12 percent nationally.

In short: West Virginians are older, poorer and sicker than most of the country.

"Whatever health statistic you look at, we're at the very bottom. You can look at literally everything: disabilities, cancer rate, heart conditions, diabetes, these are all conditions that once you have them, they will be with you for the rest of your life," said Simon Haeder, a political science professor at West Virginia University.

"One of the most dramatic differences that the ACA created is this common perception about pre-existing conditions. Not too long ago, less than a decade ago, we had people be denied for pre-existing conditions all the time. We knew about this, but everybody was kind of OK about it. And now we have the ACA, and the entire political landscape has shifted."

Morrisey first won statewide office in 2012, and won re-election in 2016 by 10 points. Given President Donald Trump's 42 point margin of victory in West Virginia in 2016 and repeated visits supporting Morrisey, the seat is ripe to slide over to Republican control. However, most independent polling has Manchin ahead.

Even Trump gets in on pre-existing conditions. At a recent Morrisey campaign event in Wheeling, Trump, an advocate of an ACA repeal, promised to protect people with pre-existing conditions.

"I will always fight for and always protect patients with pre-existing conditions, you have to do it," he said. "Some people think that's not a Republican thing to do, I don't care. And guess what - all of the Republicans are coming into that position now, and we'll do it the right way. Pre-existing conditions are safe."

From both his campaign and official office, Manchin repeatedly invokes pre-existing conditions and Morrisey's signing onto a lawsuit seeking to repeal the ACA through the judicial branch.

That lawsuit, led by the Texas attorney general, argues that because last year's tax reform legislation revoked the individual mandate to purchase health insurance - a key component of the ACA - Obamacare loses its viability as a tax law and is unconstitutional. A federal judge heard oral arguments in that case last month.

Morrisey has said he would vote to repeal the ACA and has sued the federal government over the law in the past, as well. Manchin's campaign has banked on the popularity of the ACA, taking out expensive ad buys centered on Manchin shooting the lawsuit with a rifle.

"Now the threat is Patrick Morrisey's lawsuit to take away health care from people with pre-existing conditions; he is just dead wrong, and that ain't gonna happen," Manchin says in the ad before firing.

Morrisey has denied Manchin's claim that he's attacking people with pre-existing conditions and has criticized Manchin for voting to protect the ACA. However, he has not offered any specific policy in lieu of the ACA, and did not respond to interview requests to discuss as much.

"There is no debate that we must help those with pre-existing conditions," Morrisey said in a July 20 statement through his spokesman Nathan Brand.

A host of different groups representing physicians and patients have criticized the lawsuit.

Health care premiums have steadily increased both before and after implementation of the ACA. Haeder said reasons for this are twofold. For one, put simply, health care goods and services have climbed in price annually.

According to a May 2017 report from the U.S. Department of Health and Human Services, premiums for individual health insurance plans have doubled since 2013. A report from KFF shows the average deductible for single coverage among all workers has increased by 53 percent since 2013.Secondly, the ACA requires providers to offer certain "essential health benefits" on its plans. These include 10 health care product areas like prescription drugs, pregnancy care, emergency services and others. Haeder said insurance was cheaper before because it didn't include what now seem like obvious pieces of care.

"A lot of that is because the insurance you had previously was really, really crappy, and if you had ever gotten really, really sick, you'd have noticed how crappy that insurance is," he said.

Following the lead from the top of their ticket, Democrats in the state running for the U.S. House have parroted Manchin on the pre-existing condition messaging.

Democrats Kendra Fershee, Talley Sergent and Richard Ojeda have all said they would protect the ACA, often referring to it by the ailing people it protects.

Ojeda is running against state Delegate Carol Miller, R-Cabell, who has also said she would vote to repeal the health care law if she's elected to Congress.

Both Fershee and Sergent are running against Republican incumbents - Reps. David McKinley and Alex Mooney respectively - who have repeatedly voted to repeal the ACA.

"It gets back to health care and who wants you to have it and who doesn't," Sergent said. "What we're seeing is that this is an issue that bypasses any partisan affiliation because this really affects people's lives and they are concerned about it. That's why we're talking about it, because it's important."

Reach Jake Zuckerman at [email protected], 304-348-4814 or follow @jake_zuckerman on Twitter.