A publication of the Kentucky Center for Public Service Journalism

Constance Alexander: Pre-existing conditions? It may just come down to the ‘luck of the draw’

Last week in Marshall County, silent protestors with placards claiming pre-existing conditions feigned death on the court house lawn.

Inside, seats in the courtroom were filling up. People had come from work, grocery shopping, school, the usual. Several of the older participants might have forsaken a porch rocker or a booth at McDonald’s to attend.

The mood was light, cordial, similar to the opening of the Shirley Jackson short story, ‘The Lottery,” which begins on a day described as “clear and sunny,” with “flowers blossoming profusely and the grass richly green.”

The group was there for a town hall meeting with First District Congressman James Comer. When he welcomed the crowd, he appeared eager, cheerful, ready for a down-home chat in a county where he’d won nearly 72 percent of the vote on Nov. 8. The sleeves of his fresh white shirt were rolled up; his khakis were wrinkle-free and his cowboy boots shammied to a hoe-down brown.

He began his talk by remarking that, in the past, nobody showed up at town halls.

“That has changed.” The congressman beamed at the audience with an engaging smile. “I think it’s great,” he said.
After seeing coverage of rowdy and contentious town halls on the national news, I was relieved to be in such an amenable crowd. We listened politely to his prepared remarks, but during the Q & A a few people slid to the edges of their seats when he declared, “We have to focus on reforming the health care system.”

Reform, he explained, would lead to the market controlling costs, and that something called “The MacArthur Amendment” would protect people with pre-existing conditions. “Premiums will hopefully go down with more competition,” he added.

The word “hopefully” hovered over the audience like a storm cloud.

Audience members expressed fears of losing coverage because of pre-existing conditions. The huge costs of medications and care for chronic conditions were eloquently detailed. One man spoke of his rare and threatening blood disorder that, without insurance, would require him to pay about $680,000 a year for life-sustaining medicine and equipment.

Congressman Comer’s smile tightened and the starched collar of his shirt began to wilt.

There were no definitive answers, but despite occasional boos and groans from the audience, there were no threats, no trading of insults, no profanity. For such a contentious topic, exchanges were reasonably civil.

At this stage in the legislative process, Mr. Comer explained, there is little that can be counted on. He did assert that he would fight for coverage of pre-existing conditions, but also said that a health care bill has to be passed in time for Open Enrollment in October.
…Which leads us back to “The Lottery,” a parable that examines the way society falls back on tradition.

In the story, which is one of the most famous in 20th century American literature, the ritual of a community lottery is repeated annually. The luck of the draw determines the winner, who is stoned to death by neighbors who are compliant with the system because that is what they are used to. As long as they or their families are not affected directly, they go along with it.

“It isn’t fair, it isn’t right,” the unfortunate lottery “winner” screams, and the story ends with the words: “And then they were upon her.”

I left the court house with respect for the give-and-take of the discussion, but deep misgivings about how the legislation will proceed. The road to affordable care has been littered with broken promises and empty assurances. Chances are that some kind of law will be passed at the federal level with an exit clause for states that seek waivers.

Will prices actually go down? Will pre-existing conditions be covered? Or will we go back to the old way, with a lottery-type system where “winners” lose their coverage by the luck of the draw?


Constance Alexander is a columnist, award-winning poet and playwright, and President of INTEXCommunications in Murray, Ky. She can be reached at Calexander9@murraystate.edu. Or visit her website.

Read all posts by Constance Alexander on KyForward

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