What do the candidates have to say about food allergies?

Not much specifically, butthey have a lot to say about health insurance, which affects all of us, especially those of use with higher health care needs.  Unfortunately, trying to figure out what all the political rhetoric actually means can be difficult.  I’ve turned to The Urban Institute, a non-profit, non-partisan research institution for an in-depth analysis of how the different plans will play out.  I’ve highlighted the information that is relevant to those of us living with and managing chronic illnesses, such as food allergies.  (If you’d like to read the full text of the Urban Institute report, see the link below, or check out each candidate’s web site for the full text of their health plans.)

The bottom line:

Sen. McCain’s health care plan would “make insurance less affordable and accessible for those with high health care needs” according to The Urban Institute.  The McCain plan would require more people to purchase insurance in the “non-group” market — that is, insurance that is not provided by an employer.  For people with a chronic illness, such as food allergies, this is potentially a problem.  Most states allow non-group insurers to deny coverage to people who are considered to have a high risk status (as in, having a known chronic illness.)  Sen. McCain proposes to solve this problem by funding state-sponsored “high risk pools” — insurance for those who are unable to find coverage in the private market.   However, about a third of all states do not have high-risk pools, so this option would simply not exist for residents of these states.  For residents of states with high-risk pools, high-risk insurance may simply be unaffordable.  McCain’s proposed funding for this system is not enough to cover the projected costs.

Sen. Obama’s health care plan is clearly better for people managing food allergies.  It would increase health insurance coverage so that all children in the United States would be covered.  Sen. Obama’s plan would the plan would prohibit insurance plans from denying coverage to applicants based on health status — meaning that people with chronic illnesses, such as food allergies, could not be denied health insurance because of their illness.  Sen. Obama’s plan would also make insurance more affordable for people with chronic illnesses, since it would require insurers to pool the risk of all the insured, rather than segment them into higher-risk or lower-risk pools.  (See below more my attempt to explain risk segmentation in English.)  In short:

“The Obama plan would ensure that every American citizen had a guaranteed source for purchasing or otherwise obtaining health insurance coverage, a situation that does not exist in the vast majority of states today.”

  –The Urban Institute:  An Analysis of the Obama Health Care Proposal (with my emphasis added)

In addition, Sen. Obama’s plan focuses on the management of chronic conditions as a key to keeping health costs down and improving health outcomes.  (It’s a no-brainer to those of us who are managing chronic conditions that we spend more on health care.)  He proposes increased funding for research and education on chronic diseases.  Since allergies (food and environmental) are the most frequent chronic illness in children (according to the Allergy and Asthma Foundation), we can hope that this agenda will translate into more funding for fighting childhood allergies.

What is risk segmentation and why should I care?

Insurance works by pooling risk — you get enough people together and each of them pay a little bit of money into a pool, and then if any one of them needs the money (because an anvil falls on their head, for example, and they need to go to the hospital) the cost is spread around.   The way insurance should work is that those who are less likely to need a payout at any given time keep paying into the pool, because at some point in them they may become more likely to need the money.  (You never know when you might get hit by a falling anvil.)

The McCain plan would create a system of market segmentation in which the people least likely to need a health insurance payout (young, healthy people without chronic illnesses) would be put in a separate “segment” or risk pool and charged differently than those who are more likely to need a payout (older people and/or people with chronic illnesses.)  Some people who are very likely to need payouts from their insurance would not be able to buy it at all.

Car insurance companies do this in a way — they raise your premium after you have an accident, if it is your fault.   If you have too many accidents or speeding tickets, you might get dropped from your insurance carrier.  But health insurance is different -  it is not risky behavior or poor decisions on your part that cause you to have food allergies.  Imagine if every time you needed to buy an epi pen ($110, with coverage!), your health insurance went up.  Imagine if your child was hospitalized for three days and the hospital bills were $45,000 (a not unreasonable amount these days) — and that the next time your health insurance came up for renewal, your premiums doubled.  Or your family was dropped from coverage and you were told to try to get insurance from your state’s high-risk pool.

Risk segmentation is a very bad idea for those of use who are managing chronic illnesses.

So if I or someone I love has food allergies, who should I vote for?

No question about it, you should vote for Obama.  His plan is much more likely to ensure that you keep your health insurance, and that it remains affordable, whether or not you need it.   It is also more likely to translate into increased funding for research on food allergies, education about allergies, and a revamped health system that focuses on managing chronic disease.

Can you immagine an America where every child is covered by health insurance?  I can’t, actually.  But I’d like to live to see it.

Run, don’t walk to your local polling place this year.  Don’t forget your epi pen.

Sources:

The Kaiser Family Foundation:  Health 08

The New York Times:  On the Issues:  Health Care

The Urban Insitute analysis of 2008 health care proposals

Association of Health Care Journalists

Asthma and Allergy Foundation: Allergy Facts and Figures