Pre-Existing Conditions and Wound Care: How Coverage Impacts Care

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Affordable Care Act

Paula Erwin Toth, RN, MSN, FAAN
WOC nurse

Happy Fall! This is the time of year for change: changing leaves and changing temperatures. In the USA, it is also the time for choosing a Medicare supplement and other health care plans. Last but not least, it is election time. No matter what your political beliefs, be sure to vote—early voting, absentee voting, and voting on Election Day are all options for you to consider. Many people feel as if one person‘s vote cannot make a difference. Many elections have been very close contests where small numbers of individual votes were absolutely critical to the outcome.

Pre-Existing Conditions and the Affordable Care Act

A big topic (again) is health care, especially affordable coverage for pre-existing conditions. This is a topic that concerns not only our patients, but also ourselves and our friends and family. Health care in the USA is a jumble of confusing insurance plans, regulations, and coverage. The Affordable Care Act (ACA) was intended to be a start by requiring insurance plans to cover preventive care, ensure access and affordable premiums to people with pre-existing conditions, and compete in the marketplace. For reasons too lengthy to explain in this blog, the ACA was not implemented as it was envisioned. Politics aside, our access to health care is very much based on the type (if any) of insurance a person has, as well as his or her economic status to be able to meet co-pays and deductibles.

Despite claims to the contrary, all health care providers know patients are not going to have their health care needs met in the emergency department. Health care in the USA has long been reactive rather than proactive. It costs far less to promote health and prevent illness than it does to treat someone with advanced disease. Our colleagues to the north and overseas find our approach to health care coverage bewildering. This is where politicians are the masters of fostering division and fear. Solutions need not be an all or nothing proposition. The ACA was the brainchild of the conservative Heritage Foundation and successfully implemented in Massachusetts by then Governor Mitt Romney. Instead of leading to a bipartisan approach to work on a plan to benefit all Americans, it became a battle worthy of so-called professional wrestling—lots of noise and posturing but few results.

It seems every election cycle health care becomes a contentious political talking point, and after the election it takes a backseat to other issues. Health care and our social safety net should not be partisan issues. Unfortunately, I do not see that changing anytime soon. All of us—health care providers, our patients, and their caregivers—need to look at the big picture to see what political decisions about health care mean to us. Pre-existing conditions are an especially hot political topic right now. One key part of the ACA was requiring insurance providers to provide affordable coverage for people with pre-existing conditions. Unless you were enrolled in a group plan through your employer, a person with a pre-existing condition was priced out of the market.

Conclusion

As wound care specialists, we know prevention is more effective than treatment. If persons with diabetes mellitus have no or limited access to health care providers who can teach and counsel them to manage their condition, we end up seeing them after a crisis has occurred. I cannot think of one person I know who does not have some kind of pre-existing condition that could be used to deny coverage or offer an unaffordable premium. In closing, affordable coverage for pre-existing conditions should not be a Red or Blue issue—it is a Red, White, and Blue issue that affects all Americans.

About the Author
Paula Erwin-Toth has over 30 years of experience in wound, ostomy and continence care. She is a well-known author, lecturer and patient advocate who is dedicated to improving the care of people with wounds, ostomies and incontinence in the US and abroad.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Comments

The fact is people with pre- existing conditions are paying hefty premiums. I know someone who is paying 1500 dollars a month for self insurance. The costs of services, medications and diagnostics are questionable expensive e especially when there is a range of cost across the healthcare system.

Statements articulate our concerns and well stated. Thanks Paula.

In agreement with you Paula. There is power in numbers. GET OUT and VOTE this mid term election. We know it will cost our current health care system so much more when citizens do not have health insurance because the cost is so prohibitive or they are just locked out do to pre-existing conditions! The ER will be the doctors office! the ACA isn’t perfect. Can’t we expect our elected politicians to work to improve that? Maybe we should pro-rate their pay and benefits based on their work production! When you’re not part of the solution you are indeed part of the PROBLEM!
Congress needs to get a gripe on reality and work together to improve even one issue that of health care access.

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