Opinion: Time for insurance companies to cover everybody

Although many Americans say they are doing their best to manage their health, others, especially racial minorities, have insurance plans that are not readily accepted by their health care providers. Or they simply do not have coverage at all. The consequences may be fatal. The Institute of Medicine reports that chronic illnesses -- heart disease, cancer, diabetes, stroke, and dementia -- account for 80% of deaths.

Inadequate or unaffordable employer-based health insurance for chronic illness is a barrier to care. Fortunately, Congress has a prescription to help alleviate fears. We need bold political leadership to create supportive health insurance in both the public and private markets that effectively addresses chronic illnesses.

The Kaiser Family Foundation reports 6 in 10 Americans say an immediate family member has a chronic condition that is stable with care. Regardless of political party affiliation, the vast majority of survey respondents say it is "very important" to retain provisions in insurance plans that prevent the denial of health coverage based on a person's medical history (75%) and from charging sick people more (72%). Voters -- from small rural towns and large urban cities -- recognize this reality, as do their employers.

Last year, U.S. Rep. Greg Walden (R-Ore.) introduced an amendment to the Public Health Service Act that would prohibit discrimination in insurance coverage for persons with chronic illnesses and included plans purchased in the individual and group markets -- the source of employer-sponsored coverage for a majority of Americans. Walden and 71 other Republican co-sponsors of the bill reflect shifting trends in the politics of health insurance.

The Republican commitment to improving coverage in states such as Texas and Georgia is a dramatic shift. Research has shown persistently high death rates over the past 50 years in a region encompassing West Virginia and sweeping south and west. During this period, several landmark pieces of legislation were enacted to strengthen public plans and private insurance markets. This new interest in promoting policies designed to boost insurance coverage for their constituents' health is particularly good news for persons with preexisting conditions in these states who are otherwise enduring high out-of-pocket expenses.

The experience of protracted illness without coverage is all too familiar and potentially deadly. Caregivers, for example, leave jobs with benefits to provide uncompensated care for family members. Caregivers with chronic conditions often are ineligible for public plans such as Medicare or Medicaid. Our research documents this vulnerability. The combination of no coverage and unstable illness is highest among women of pre-retirement age.

Senate Bill 470, or the Medicare at 50 Act, specifically removes the Medicare eligibility barrier by providing the option for any citizen age 50 to 64 to buy into Medicare. Given widespread political support -- 85 percent of Democrats, 75 percent of independents and 69 percent of Republicans -- lawmakers should work together and pass this legislation.

To do this, Congress must respond to major concerns. Hospitals fear that a Medicare "buy-in" program would lead to a crowd-out of the private insurance market of older workers, incentivizing early retirement, that would result in increasing costs of Medicare hospital reimbursement. Lawmakers must weigh the benefits of the bill against the cost because it would begin to address the health care needs of an estimated 65.7 million adults.

Lawmakers such as U.S. Sen. John Cornyn are poised to reach across the aisle in passing legislation given that he and his colleagues already support measures that bar insurance companies from denying coverage for preexisting conditions. Existing legislation provides this critical protection. While the Affordable Care Act is under review by federal courts, vital protections for conditions such as depression, diabetes and dementia must not be lost.

The choice is clear. Eighty percent of Americans believe that the federal government should require insurance companies to cover everyone. Delaying or denying coverage to those with preexisting illnesses and conditions is not only a costly decision; it is a moral miscalculation where justice is inevitably denied.

This gap is intolerable. Both Republicans and Democrats need to heed the call to work together and break the stalemate on the politics of health insurance.

Angel is a professor in the LBJ School of Public Affairs at the University of Texas. Miles is a professor of epidemiology and biostatics at the University of Georgia.

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