The New Health Dialogue

More than one in five Americans (under Medicare age) have a pre-existing condition, according to a Families USA report. Pre-existing conditions, which can be anything from cancer to diabetes to high blood pressure to a past sexual assault, are frequently used by insurers to deny coverage to people trying to purchase health insurance on the individual market. So according to the report, “Health Reform: Help for Americans with Pre-Existing Conditions,” approximately 57.2 million people under the age of 65 (22.4 percent) of Americans are at risk of being denied coverage. And that’s just counting diagnosed pre-existing conditions. The true number could be even higher. (Keep reading to learn how this will change under health reform!)

Though pre-existing conditions can affect all age groups (even babies are denied coverage because of them), they are more likely to hit older and poorer people. Only 15.9 percent of young adults aged 18 to 24 have a pre-existing condition that could lead to a denial of coverage, compared to 35.3 percent of adults aged 45 to 54 and 45.5 percent of adults aged 55 to 64. Additionally, already vulnerable low-income Americans are more likely to have a pre-existing condition.

Out of all income groups, 24.2 percent of those below the federal poverty level have been diagnosed (that’s a yearly income of $22,050 for a family of four and only $10,830 for an individual). However, the problem is not isolated to lower-income levels. Out of the entire nonelderly population, middle and upper income families (above 200 percent FPL) make up a little under 70 percent of the diagnosed population. In terms of race and ethnic populations, American Indians and Alaska natives are the most likely to be affected (25.9 percent). About one-quarter of whites, and one-quarter of African Americans, and one-sixth of Hispanics are also affected by pre-existing conditions.

Eliminating pre-existing conditions is a popular provision in the new health reform law. According to recent polls, approximately 3 out of 4 of Americans believe that ending coverage denials because of pre-existing condition is “extremely or very” important. The law accomplishes several significant steps forward in ensuring that those with pre-existing conditions can get coverage:

1. The first is establishing high risk pools. Starting at the end of June, individuals with pre-existing conditions who have been uninsured for the past six months will be eligible to enroll in a national high risk pool. The pools are intended to be temporary -- they will expire when the health insurance exchanges launch. It's not yet completely clear how many people will be able to get coverage this way, or what it will cost.

2. The state-based Health Benefit Exchanges will start in 2014. The exchanges allow Americans, including individuals with pre-existing conditions who cannot get affordable coverage elsewhere, to shop for quality health insurance. In this new insurance marketplace envisioned by national health reform, everyone will be required to purchase insurance -- which in turn means that no one can be denied insurance because of a pre-existing condition. Through the exchanges, consumers will have access to affordable, quality coverage and transparent information about benefit design.

3. Also, starting this year, insurers cannot deny coverage to children with pre-existing conditions. The report estimates that five million children under age 18 have been diagnosed with such a condition. Though this requirement doesn’t become law until September, insurers capitulated to pressure from HHS and agreed to start covering children immediately.

As the Families USA report says,

The protections that health reform offers mean that every American will now have greater security and peace of mind, knowing that insurance companies will be required to sell health insurance to all individuals regardless of their health status, to charge them the same premiums rather than making them pay more, and to cover all benefits. These new protections mean that every American will always be able to purchase quality, affordable coverage.