Toomey Compares Patients With Preexisting Conditions to Burned-Out Houses

Pat Toomey has taken a lot of flak since Donald Trump won the presidency. The Pennsylvania senator, who revealed he had decided to vote for Trump only on Election Night, has been protested weekly by the “Tuesdays With Toomey” group.

But, hey, that’s what happens when you’re in the majority party and you voted for the unpopular president. And so going around liberal internet today is this clip of Pat Toomey comparing people to houses.

Toomey made the analogy on Tuesday at the second hearing for Human Health and Services secretary nominee Tom Price, currently a congressman from Georgia. As John Micek at The Patriot-News also noted, the clip doesn’t really tell the entire story. But Toomey also didn’t get an answer to his question — and didn’t press for one, either.

Toomey opens his questioning of Price, the HHS nominee, by saying that 43 percent of Pennsylvanians buying insurance through the Affordable Care Act exchanges have just one choice of insurer. “When we talk about repeal, sometimes I hear people say we’ve got to keep coverage of pre-existing conditions. When I hear that, I think we are missing something,” Toomey goes on to say. “There’s obviously a number of Americans who suffer from chronic, expensive health care needs. They have had these conditions all their lives or some other period of time. For many of them, the proper care for these conditions is unaffordable.

“I think we agree that we want to make sure those people get the health care they need. One way to force it is to force insurance companies to provide health insurance coverage as soon as they show up, regardless of what condition they have, which is kind of like asking the property casualty company to rebuild the house after it has burned down.

“But that is only one way. Am I correct — is it your view that there are perhaps more effective ways, since Obamacare is in a collapse, to make sure that people with these chronic conditions that they need at an affordable price without necessarily having the guaranteed issue mandate in the general population?”

Price replies, but doesn’t answer the question. “I think there are other options,” he said, “and it is important to appreciate the position we currently find ourselves in with policy in this nation is that those folks are going to have nothing because of the collapse of the market.”

“Right,” Toomey replies, then moves on to his next question about making health care more “patient friendly.”

There may be a way for patients with preexisting conditions to get health care at an affordable cost without the Affordable Care Act’s individual mandate, but we didn’t learn anything about it from Pat Toomey or Tom Price at yesterday’s hearing. Toomey didn’t press him on it — he basically just asked if alternative (and perhaps better) ideas existed. His analogy was crude, and perhaps inappropriate, but he does say he wants people with preexisting conditions to get coverage.

So I asked Toomey’s office what he wanted to replace the individual mandate and the requirement that insurance companies cover people with pre-existing conditions.

“Senator Toomey was making an analogy about how insurance markets work, and why Obamacare is in the midst of a ‘death spiral,’ where prices for insurance continue to rise, and healthier, wealthier and younger Americans are finding it more appealing to go without insurance,” Steve Kelly, a spokesperson for Pat Toomey, wrote to Philadelphia magazine in an email. “His point is there are multiple ways to help people with very expensive, chronic illnesses aside from mandating all Americans buy high-cost insurance and requiring all insurers to sell products to anyone – even after a person has been diagnosed or entered treatment for an illness.”

Toomey’s spokesperson continued: “Other approaches to help those with costly chronic conditions include the use of state-based high-risk pools as well as extending the incentives for individuals to maintain credible coverage, which currently exist in the employer-sponsored market, to the individual market.”

Before the Affordable Care Act, high-risk pools existed in 35 states. Such states pooled people with costly pre-existing conditions and often helped insurance companies pay for the cost of coverage. But it didn’t quite work. “In many cases, the high-risk pools were overburdened financially, leaving many people without insurance or with tight restrictions on coverage,” the New York Times wrote earlier this week. “Insurers refused to cover the individuals who were likely to have the highest expenses, like those who had H.I.V. or serious kidney disease, and the pools lost money.”

And not everyone was covered. Eighty percent of the people who applied for the high-risk pool in the state of Washington were turned away, per that Times article. There’s often a lifetime cap on treatment payments. And, as potentially sick people are thrown into one pool, the cost of coverage is much higher.

National Affairs, a conservative journal, wrote in 2011 that there was a simple fix to cover patients with pre-existing conditions: “If households, not firms, chose and controlled their own insurance plans, people would no longer face the risks that come with changing coverage based on new employment arrangements …. But moving to true insurance portability will not be easy. It will require fundamental reform of the tax treatment of health insurance in order to level the playing field between plans owned by employers and those owned by individuals, as well as a reworking of some current insurance regulations.” That seems unlikely to happen. The journal then also suggested high-risk pools, perhaps with federal funding.

Bash Toomey’s analogy if you want. But I think the real anger could be directed at Tom Price for dodging questions about an Obamacare replacement — and Toomey for letting him.