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Georgia insurance commissioner Ralph Hudgens — the man in the state responsible for regulating the insurance industry — doesn't appear to have a robust sense of the role of "insurance." Requiring insurers to cover pre-existing medical conditions, he told a group last month, is like getting into a car accident and then asking for auto coverage.

The video, obtained by the Atlanta Journal-Constitution (and via ThinkProgress), shows Hudgens speaking at a CSRA Republican Women’s Club dinner. Insurers warn that their costs will rise if they have to cover pre-existing conditions, he says, and then explains why such coverage doesn't make sense in his view.

"Say you're going along and you have a wreck. And it's your fault. Well, a pre-existing condition would be you then calling up your insurance agent and saying, 'I would like to get collision insurance coverage on my car.' And your insurance agent says, 'Well, you never had that before. Why would you want it now?' And you say, 'Well, I just had a wreck, it was my fault and I want the insurance company to pay to repair my car.' And that's the exact same thing on pre-existing insurance."

This is actually not the exact same thing as pre-existing insurance. Pre-existing insurance coverage is coverage that is available to you even if you have a pre-existing condition, like a congenital disease or cancer or chronic back pain. These are not things that most rational people would determine to be "your fault"; we weren't able to find any examples of people who were born with chronic ailments that stemmed from their own behavior. Though we admittedly didn't look very hard.

We'll skip ahead a bit and note that Hudgens is really just saying that the costs incurred by insurers are more important than the costs incurred by sick people. Obamacare — which Hudgens swore he would do "everything in [his] power" to obstruct — mandates that insurers cover people regardless of their conditions precisely because of the expense that they can incur over the long term if no coverage is available. It's what insurance is supposed to do, after all.

The Affordable Care Act mandates individual insurance coverage so that insurers have more money coming in that can help them cover the costs of more expensive patients. The goal is that far fewer people have to file for bankruptcy because they're diagnosed with cancer or because they actually had a real car accident — even if it's their fault! — and ended up in the hospital for a week. Insurers don't like having to cover those chronically ill patients, but the system is set up specifically so that they don't take too big a hit. Hudgens finds their pain more compelling than Georgians'.

A better analogy between auto insurance and mandated pre-existing coverage is this. Say you bought a car that you didn't realize had bad brakes, and you needed the car for work and couldn't afford another one. You get in minor fender benders or bigger accidents with some regularity, but you literally can't not drive it. So you go to an insurer and explain the situation. It used to be that the insurer would tell you to go to Hell. But since it is now getting more payments from people who never use their cars at all or with flawless safety ratings, they can much more easily cover your car, too. It's not as good a punchline, but it seems like the sort of distinction a state insurance commissioner should be able to draw.

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