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Insurance coverage for people with pre-existing medical conditions.
One attack comes in a TV ad released Sept. 20, 2018. Using a nurse who had breast cancer as the speaker, Baldwin makes a two-part claim:
2.4 million Wisconsin residents have a pre-existing condition
Vukmir supports letting insurance companies "deny coverage to people with pre-existing conditions"
Vukmir took the unusual step of rebutting the ad by posting a letter to the nurse on Twitter.
All of this is tied to the Affordable Care Act (Obamacare) and its prohibition on insurers denying coverage to people with pre-existing conditions — something that is threatened by Republican efforts, which are supported by Vukmir, to repeal the law.
So, let’s check both parts of Baldwin’s claim.
The higher the number it is that Baldwin chooses is significant, because it would mean that many more people are potentially vulnerable if the second part of her claim is true.
One of the most popular provisions of the Affordable Care Act is its requirement that insurers cover people with pre-existing conditions. That is, if you don’t have health insurance from an employer or the government, you have guaranteed access to insurance in the individual market, regardless of your health, and you can’t be charged higher rates for a pre-existing condition.
Before Obamacare, insurers typically used medical underwriting — evaluating the health status, health history and other risk factors of an applicant — to determine whether to deny a person coverage. Even for people they did accept, insurers could carve out coverage of any specific pre-existing conditions, as well as charge people with health problems higher premiums.
To back Baldwin’s 2.4 million people figure, her campaign pointed us to an estimate by the Center for American Progress, a progressive public policy research and advocacy organization based in Washington, D.C.
But this is a broad count. It includes not only people who could be denied insurance coverage — which is what Baldwin highlights in the TV ad — but also people who could buy coverage but be charged more because of a pre-existing condition.
In contrast, the latest estimate by the nonprofit Kaiser Family Foundation, one of the gold-standard sources on health care, is based on the number of people in Wisconsin who had health conditions that likely would have left them uninsurable before the Affordable Care Act. That estimate is much smaller: 852,000.
So, there is a basis for Baldwin’s 2.4 million figure. But it’s misleadingly high in the context of the second part of her statement.
It is worth noting, that if the Affordable Care Act were repealed, it’s possible premiums for some people with pre-existing conditions could be so high as to make insurance virtually unaffordable.
Vukmir has not specifically said that insurers should be able to deny coverage to people with pre-existing conditions, and she has said people with pre-existing conditions should be covered. But she has been vague on how that would happen. She has proposed "allowing insurers to offer a wider variety of plans" and enabling people to buy insurance across state lines.
When Baldwin’s ad says Vukmir supports letting insurance companies "deny coverage to people with pre-existing conditions," a footnote on the screen refers to three news stories, but only one that mentions Vukmir.
That story, by the Wisconsin State Journal, reported how Vukmir wants to fully repeal Obamacare — which would mean also eliminating its guarantee against insurers denying coverage to people with pre-existing conditions.
The story also notes that Vukmir has supported GOP repeal bills in Congress that would weaken protections for people with pre-existing conditions. For example, she praised the GOP’s American Health Care Act. It would have kept the requirement that people with pre-existing conditions must be offered health insurance -- but it would have dropped Obamacare’s rules capping how much extra those people could be charged.
And the story reports that Vukmir supports returning to what Wisconsin offered before Obamacare — a publicly-subsidized high-risk pool for people with pre-existing conditions who couldn’t get insurance.
Wisconsin’s high-risk pool was held up as something as a model, at least for the people it covered. But it worked only for people who could afford the insurance in the first place — and many people with pre-existing conditions could not afford coverage from the high-risk pool, as it covered fewer than 25,000 people.
In responding to Baldwin’s TV ad, Vukmir’s campaign pointed to a news release it issued in which Vukmir alludes to the high-risk pools, saying Wisconsin "had solutions for those with pre-existing conditions before it was cool to take care of people with pre-existing conditions." But the release didn’t offer more specifics on how they would be covered.
Wisconsin’s high-risk pool existed specifically because insurers were allowed to deny coverage to people with pre-existing conditions.
Moreover, the pool, unlike Obamacare, did not provide coverage for everyone who couldn’t get coverage because of a pre-existing condition.
Baldwin said "2.4 million people in Wisconsin have pre-existing conditions" and Vukmir supports letting insurance companies "deny coverage to people with pre-existing conditions."
There is some basis for the first part of Baldwin’s statement. One estimate puts the number of at 2.4 million — but those that could be denied health insurance coverage because of a condition is estimated to be much smaller, 852,000.
On the second part of Baldwin’s statement, Vukmir has indicated that high-risk pools are a solution for covering people with pre-existing conditions. But those were in place because -- before the Affordable Care Act, which Vukmir wants to repeal -- insurers were allowed to deny coverage to people with pre-existing conditions. And Wisconsin’s high-risk pool covered only a fraction of people with pre-existing conditions.
That being said, Vukmir has not specifically said she supports allowing insurers to deny coverage to people with pre-existing conditions, and she has said those should be covered — even if she has been vague about how that would happen.
For a statement that is partially accurate, we give Baldwin a Half True.
YouTube, Tammy Baldwin "Both sides" TV ad, Sept. 20, 2018
Interview, Leah Vukmir campaign spokesman Jahan Wilcox, Oct. 8, 2018
Email, Tammy Baldwin campaign spokesman Bill Neidhardt, Oct. 4, 2018
Center for American Progress, "Number of Americans with Pre-Existing Conditions by Congressional District," April 5, 2017
Milwaukee Journal Sentinel, "Covering people with pre-existing conditions is popular, problematic," May 29, 2017
Milwaukee Journal Sentinel, "Fates of some people with pre-existing conditions uncertain if Affordable Care Act is suspended," Sept. 20, 2018
Milwaukee Journal Sentinel, "Wisconsin U.S. Senate race: Tammy Baldwin, Leah Vukmir clash on health care," Sept. 4, 2018
Kaiser Family Foundation, "Mapping Pre-existing Conditions across the U.S," Aug. 28, 2018
Kaiser Family Foundation, "High-Risk Pools For Uninsurable Individuals," Feb. 22, 2017
Kaiser Family Foundation, "Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA," Dec. 12, 2016
Wisconsin State Journal, "There may be no US Senate race with a starker contrast on health care than in Wisconsin," Aug. 27, 2018
National Public Radio, "Under New Rules, Cheaper 'Short-Term' Health Care Plans Now Last Up To 3 Years," Aug. 1, 2018
Vox, "How Cassidy-Graham brings back pre-existing conditions," Sept. 18, 2017
Leah Vukmir campaign website, "Repeal Obamacare," accessed Oct. 4, 2018
PolitiFact North Carolina, "Does new version of the AHCA protect coverage for pre-existing conditions?" May 4, 2017
PolitiFact Ohio, "Does Ohio's Mike DeWine want to get rid of pre-existing condition coverage?" Oct. 4, 2018
Leah Vukmir campaign, news release, Aug. 31, 2018
Email, Kaiser Family Foundation senior fellow Karen Pollitz, Oct. 5, 2018
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