Fox Rushes To Discredit HHS Study On Pre-Existing Conditions

››› ››› ANDY NEWBOLD

Fox News has repeatedly attempted to discredit an HHS study estimating how many people have pre-existing conditions. In doing so, Fox falsely claimed the study said 129 million people would "lose their coverage" if Republicans repealed the health care reform law, when in fact, HHS said this number represents those who, in the absense of health care reform, would face higher premiums or benefit cuts in the individual insurance market.

Fox News Misrepresents HHS Report To Suggest It Isn't Credible

Megyn Kelly: "The Math Is Interesting." On the January 18 edition of Fox News' America Live, host Megyn Kelly falsely claimed the HHS report said 129 million Americans "are going to lose their coverage" if Republicans successfully repeal the health care reform law:

KELLY (HOST): Less than 24 hours before the House holds a historic vote to repeal the health care overhaul law, the Obama administration launches a big attack against repeal efforts, suggesting that half of this country could lose their insurance coverage if the Republicans are successful in uprooting this legislation.

The Health and Human Services Secretary Kathleen Sebelius issuing that dire warning today. Some GOP lawmakers are already calling this a political PR stunt by the administration and say those numbers are grossly exaggerated. We are now awaiting a news conference with some key Republicans and Congressman Steve King of Iowa is one of them. He joins us live with a preview, you might say, from Washington. Congressman, thank you so much for coming back on the program. So none other than the Health and Human Services Secretary comes out and says 129 million Americans have pre-existing conditions and that if you repeal this law these are the folks who are going to get hurt and are going to lose their coverage.

[...]

Welcome to America Live everyone. I'm Megyn Kelly.

KELLY: The math is -- I don't know, I mean, the math is interesting because they said that the Obama health care bill gave coverage to 30 million Americans, and now they're saying if you repeal it 130 are going to lose coverage. So, we'll look forward to your press conference as you guys crunch the numbers and try to figure out that disparity. [Fox News', America Live, 1/18/11]

Fox Medical Contributor Alvarez: "I Don't Buy This," "The Math Doesn't Add Up." From the January 18 edition of Fox News' Happening Now:

JON SCOTT (HOST): Alright, here's what you need, another government study. Last hour we talked about this new government study that finds up to half of you, half of all Americans under the age of 65 could have a preexisting medical condition, the kind that may disqualify you from getting health private insurance. Dr. Manny Alvarez is here to bring us his medical fact check he is senior managing editor foxnewshealth.com and a member of the Fox News medical A Team. You don't buy this?

DR. MANNY ALVAREZ: I don't buy this. I mean, come on, this is a couple of days before a very serious vote in Congress. Look, preexisting medical conditions is a reality. They've been around for a long, long time. You know, this is something we have been talking about -- rates of diabetes, obesity, hypertension, you get the whole thing. But to say 129 million people have preexisting conditions that may put you at risk for losing your insurance is a little bit of hot air in my opinion.

You know, we see pre-existing conditions all the time in the hospitals and a lot of the hospitals are being -- beds are filled with patients that come in with uncontrollable diabetes, and we still have issues with smoking and excessive alcohol drinking. All of that is true. But for sure, the math doesn't add up. I mean, if that would be the case, these 129 million Americans would have lost their insurance a long time ago, and I don't think that that's the case. [Fox News' Happening Now, 1/18/11]

Stuart Varney Asked If HHS Is "Making Up Numbers" From the January 18 edition of Fox Business Network's Varney and Co:

VARNEY: Now, we've got a report and it came out today, and it says about half of all Americans under the age of 65 have pre-existing health conditions that could be red flags to health insurers. But under Obamacare, they will have to be covered. Who is going to pay for all of that?

[...]

VARNEY: 129 million Americans, this report from the government says, have pre-existing conditions. And that report is released on the very day that the House starts to debate repeal of health care reform. Is this window dressing? Is it making up numbers?

REP. CONNIE MACK (R-FL): Well, let's get the facts. So this is a report by this government and those that have been leading this government want Obamacare. So I would question the report in general, whether or not it is telling us the facts. [Fox Business Network's Varney and Company, 1/18/11]

Varney Claimed HHS Inflated The Number By Including People With "Less Chronic Conditions." From the January 18 edition of Fox News Networks' America's Newsroom:

MARTHA MCCALLUM (co-host): This new report, it comes from the Department of Health and Human Services, that's the origin of it. It claims that 129 million Americans have pre-existing conditions. Under the new health care law, those people are protected from being rejected by insurers and from paying more from coverage.

BILL HEMMER (co-host): So there are several questions on this: Are the numbers accurate, number one, and why are they being released today? Stuart Varney, Fox Business Network, some obvious answers now. Good morning.

VARNEY: Good morning, Bill. OK, number one, it makes a great headline doesn't it? A hundred and twenty-nine million people are going to be helped by Obamacare.

HEMMER: Under the age of 65, they say.

VARNEY: Correct. That's a very large number. Is that number accurate? Well the number of people who actually have the kind of chronic conditions which would exclude them from private insurance, that's probably far lower.

A study conducted by Henry Waxman, Democrat, from 2007-2009 put the number at 650,000 people who were absolutely excluded from coverage because of these chronic conditions. The study arrived at that big number by including a lot of people who were simply bothered, quote unquote, by a less chronic conditions. They chucked those people into the big number to arrive at a big number, and that number is released today perhaps politically because today there is that House vote on repealing Obamacare. [Fox News' America's Newsroom, 1/18/11]

HHS Report Estimates How Many Could Benefit From Protections For Those With Pre-Existing Conditions

129 Million Figure Includes Those That Would Face Higher Premiums Or Cuts In Coverage Because of Pre-Existing Conditions If Buying In Individual Market. The January 18 study released by the Department of Health and Human Services concluded that "50 to 129 million (19 to 50 percent of) non-elderly Americans have some type of pre-existing health condition." Contrary to Kelly's claim that HHS says 129 million would "lose their coverage," if health care reform was repealed, this figure includes those who "would at least get charged a higher premium but could also have benefits carved out or be denied coverage altogether" if they tried to buy insurance in the individual market in the absence of the health care reform law. From the study:

Because pre-existing conditions are determined by insurer practices which vary, two estimates of the number of non-elderly individuals likely to be denied coverage in the individual market were constructed. The first includes only conditions that were identified using eligibility guidelines from State-run high-risk pools that pre-dated the Affordable Care Act. These programs generally insure individuals who are rejected by private insurers. As such, the "lower bound" estimates are people with a health problem likely to lead to a denial or significant mark-up or carve-out of benefits. The second includes additional common health and mental health conditions (e.g., arthritis, asthma, high cholesterol, hypertension, and obesity) that would result in an automatic denial of coverage, exclusion of the condition, or higher premiums according to major health insurers' underwriting guidelines identified using internet searches. Individuals with these conditions would at least get charged a higher premium but could also have benefits carved out or be denied coverage altogether. Both estimates are based on the most recent data available for 2008 (for a full description, see the Methodology section). [healthcare.gov, 1/18/11]

HHS Report Highlights How Many People Would Have Limited Access To Insurance If They Left Their Jobs Or Had Other Life Changes. The HHS study clearly notes that many of those with pre-existing conditions are already insured through their employer, but states that without the protections in health care reform, they could have limited access to insurance if they left their job or experienced other life changes affecting their insurance, such as divorce:

As many as 82 million Americans with employer-based coverage have a pre-existing condition, ranging from life-threatening illnesses like cancer to chronic conditions like diabetes, asthma, or heart disease. Without the Affordable Care Act, such conditions limit the ability to obtain affordable health insurance if they become self-employed, take a job with a company that does not offer coverage, or experience a change in life circumstance, such as divorce, retirement, or moving to a different state.

[...]

The percentage of people with pre-existing conditions varies by insurance status - with the highest rates among those with employer-sponsored insurance, ranging from 21 to 54 percent (see Figure 2). Generally, pre-existing conditions matter less for people insured through employers that have a large risk pool and can therefore spread the cost of workers' illnesses or injuries. In addition, some insurance protections already exist for people changing jobs.

However, 32 to 82 million people with both health problems and job-based coverage would be vulnerable without the new law. Increasingly, employers have used annual and lifetime limits on benefits to keep their health insurance costs down. In 2009, roughly 94 million Americans were in employer-sponsored insurance with a lifetime limit.11 The new health reform law has already banned lifetime limits in private insurance and has restricted annual limits for group and new individual market plans before banning such limits in 2014. This protects workers and their dependents with health conditions, whose coverage may have otherwise run out with a serious accident, disease that involves intense care, or other high-cost illness.

In addition, workers with a pre-existing condition may be less able to change jobs for fear of losing that coverage. Chronically ill workers are 40 percent less likely to leave their job if they get insurance through it compared to those that get insurance elsewhere.12 This "job lock" is common: individuals and families often make job and career decisions based on protecting insurance for themselves or a member of their family who may not otherwise have health insurance. This is especially true among older workers, the majority of whom have a pre-existing condition. Such workers may want to take early retirement, reduce their hours to part-time work, or go into business on their own, but that is often not possible given the likely loss of employer-based and non-underwritten health insurance. There are similar issues with changes in family status: getting divorced or aging out of eligibility for dependent coverage, for example, could also limit insurance access for people with pre-existing conditions in a system without the protections of the Affordable Care Act. [healthcare.gov, 1/18/11]

Waxman Study Cited By Fox Does Not Contradict HHS Study, But Rather Estimated How Many People Have Already Been Denied Coverage By Four Companies. On America's Newsroom, Varney cited a study conducted by Henry Waxman to suggest the HHS study provided inflated numbers. However, the Waxman study did not estimate the total number of people with pre-existing conditions, as HHS has, but rather the number of people who were denied coverage for pre-existing conditions by four companies. From the October 12, 2010, study done by the Committee on Energy and Commerce, chaired by Waxman:

From 2007 through 2009, the four largest for-profit health insurance companies, Aetna, Humana, UnitedHealth Group, and WellPoint, refused to issue health insurance coverage to more than 651,000 people based on their prior medical history. On average, the four companies denied coverage to one out of every seven applicants based on a pre-existing condition. One of the four companies maintained a list of over 400 medical diagnoses that triggered a permanent denial of health insurance coverage to applicants.

From 2007 through 2009, the number of people denied coverage for pre-existing conditions increased at a rapid rate. The number of individuals denied coverage by Aetna, Humana, UnitedHealth Group, and WellPoint increased from 172,400 in 2007 to 257,100 in 2009, an increase of 49%. During the same period, applications for enrollment increased by only 16%.

From 2007 through 2009, Aetna, Humana, UnitedHealth Group, and WellPoint refused to pay 212,800 claims for medical treatment due to pre-existing conditions. In some cases, the companies offered health insurance to individuals with pre-existing conditions, but used medical riders to exclude coverage or increase deductibles for the pre-existing conditions. In the case of one of the companies, nearly 15% of the company's customers in the individual market in 2010 had policies with riders limiting coverage or increasing deductibles for certain medical conditions. [Committee on Energy and Commerce, 10/12/10]

McClatchy: Republicans "Offered No Specific Evidence To Contradict The HHS Report." From a January 18 McClatchy Newspapers report:

The Department of Health and Human Services released a report that as many as 129 million people, or about half the under-65 population, have a pre-existing condition that could jeopardize their ability to get insurance.

The 2010 law makes it illegal for insurers to deny coverage because of such conditions, but the terms won't be fully phased in until 2014.

Republicans fired back, deriding the Obama administration's claims as overblown, though they offered no specific evidence to contradict the HHS report. [McClatchy, 1/18/11]

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