Millions of women were denied coverage because of a range of health issues labeled as pre-existing conditions, including pregnancy, breast cancer, and irregular periods. Black and Latino women face higher rates of many chronic illnesses.
Full Answer
Could ‘129 million Americans with a pre-existing condition’ be denied health insurance?
Sep 28, 2013 · Twenty-Five Percent Of Adults Under 65 Say They Or A Family Member Have Been Denied Coverage Or Charged More For Having Pre-existing Condition.
Are people with pre-existing health conditions protected?
Oct 31, 2011 · People who work in small businesses, along with their employers, may be discriminated against by their insurers due to a pre-existing condition. About 25 percent of people with employer-based coverage are in small group policies. 13 In most States, insurers can engage in experience rating, or take into account the cost of workers or family members with pre …
How many Americans are denied medical care?
Feb 04, 2011 · U.S. Department of Health and Human Services. “New report: 129 million Americans with a pre-existing condition could be denied coverage without new health reform law.” News release.
Why are people with pre-existing conditions uninsured?
Jun 25, 2018 · A bygone pre-existing condition shouldn’t keep my son from getting health insurance. By Doug Hirsch. June 25, 2018. Reprints. The author and his son Zade during a trip to Montana in 2008 ...
Can you be denied for preexisting conditions?
What are pre-existing conditions exclusions?
What percent of Americans have pre-existing medical conditions?
Which pre-existing conditions are not covered?
Insurers maintained lists of health conditions for which applicants would routinely be denied coverage. Declinable conditions included AIDS/HIV, congestive heart failure, diabetes, epilepsy, severe obesity, pregnancy, and severe mental disorders.Oct 1, 2020
What are the most common pre-existing conditions?
What is pre-existing condition limitation?
Is Parkinson's considered a pre-existing condition?
Is pregnancy a pre-existing condition 2021?
Why would someone use cobra?
Is High Cholesterol a pre existing medical condition?
Are pre-existing conditions covered by health insurance?
Will private health insurance cover pre-existing conditions?
How many non-elderly Americans have pre-existing conditions?
Between 50 and 129 million non-elderly Americans have at least one pre-existing condition that would threaten their access to health care and health insurance without the protections of the Affordable Care Act. This represents 19 to 50 percent of non-elderly Americans.
How many people have pre-existing conditions?
As many as 82 million Americans with employer-based coverage have a pre-existing condition, ranging from life-threatening illnesses like cancer to chronic conditions like diabetes, asthma, or heart disease. Without the Affordable Care Act, such conditions limit the ability to obtain affordable health insurance if they become self-employed, take a job with a company that does not offer coverage, or experience a change in life circumstance, such as divorce, retirement, or moving to a different state. Older Americans between ages 55 and 64 are at particular risk: 48 to 86 percent of people in that age bracket have some type of pre-existing condition. And 15 to 30 percent of people in perfectly good health today are likely to develop a pre-existing condition over the next eight years, severely limiting their choices without the protections of the Affordable Care Act.
What are the protections of the Affordable Care Act?
A number of protections have already been put in place by the Affordable Care Act in 2010 and 2011 to increase access to health care coverage for those who need it. Insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying as dependents on their parents’ coverage up to the age of 26 if they lack access to job-based insurance on their own, and insurers cannot deny coverage to a child because of a pre-existing condition. Thousands of uninsured people with pre-existing conditions have enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan (PCIP), which has already saved people’s lives by covering services like chemotherapy.
How many non-elderly Americans were uninsured in 2009?
With the declines in employer-sponsored coverage and individual market coverage, the number of non-elderly uninsured climbed to 50 million in 2009 – nearly one in five non-elderly Americans. The growing number of uninsured, particularly those with pre-existing conditions, has both health and cost consequences.
What is a pre-existing condition?
A “pre-existing condition” is a health condition that exists before someone applies for or enrolls in a new health insurance policy. Insurers generally define what constitutes a pre-existing condition. Some are obvious, like currently having heart disease or cancer. Others are less so – such has having asthma or high blood pressure. While insurers generally determine the presence of a pre-existing condition based on an applicant’s current health status, sometimes a healthy applicant can be deemed to have a pre-existing condition based on a past health problem or evidence of treatment for a particular condition.
Why are small businesses discriminated against?
People who work in small businesses, along with their employers, may be discriminated against by their insurers due to a pre-existing condition. About 25 percent of people with employer-based coverage are in small group policies. 13 In most States, insurers can engage in “experience rating,” or take into account the cost of workers or family members with pre-existing conditions within the employer group. As such, workers’ rates may spike with one worker’s illness or injury. In addition, small businesses are susceptible to having to scale back or drop coverage when they hire a worker with a pre-existing condition, or when one of their workers gets sick. Small businesses pay on average 18 percent more than large businesses for comparable coverage, in part due to the challenges of covering people with pre-existing conditions. 14
How many people lost health insurance in 2009?
Yet, the need for individual market coverage has increased as job-based insurance has decreased. From 2007 to 2009, five million Americans lost employer-sponsored health insurance; the percentage of non-elderly Americans with employer-sponsored insurance dropped from 68 percent in 2000 to 59 percent in 2009. 3 The percentage of small businesses that offer coverage to their employees dropped from 68 percent in 2001 to 59 percent in 2009 – although rose in 2010, in part, due to the Affordable Care Act’s small business tax credits. 4 Despite the growth in the number of people without employer-sponsored insurance, coverage in the individual market has remained at about 5 percent of non-elderly Americans – and declined according to another survey. This is likely due to the increasing unaffordability and unattractiveness of individual insurance products, and to insurers’ increasing success in screening out applicants with pre-existing conditions. 5
How many people were denied medical care by health plans in the first six months of Bush's term?
Over 7.5 Million People Denied Medical Care By Health Plans In First Six Months Of Bush's First Term. According to data from the Census Bureau and a report from the Henry J. Kaiser Family Foundation analyzed by Families USA, " [M]ore than 7.5 million people experienced a problem with their health plan that resulted in a denial or delay of health care" in the month from President George W. Bush's inauguration to June 2001. Families USA wrote:
Why was a woman denied breast cancer coverage?
Woman Denied Coverage For Breast Cancer Because She Wasn't Diagnosed At Correct Clinic. From The Wall Street Journal:
Why did Beaton visit a dermatologist?
The reason? In May 2008, Beaton had visited a dermatologist for acne. A word written on her chart was interpreted to mean precancerous, so the insurance company decided to launch an investigation into her medical history.
What kind of cancer did Robin Beaton have?
Robin Beaton found out last June she had an aggressive form of breast cancer and needed surgery -- immediately.
How much higher is the risk of death for people without health insurance?
The Harvard study found that people without health insurance had a 40 percent higher risk of death than those with private health insurance -- as a result of being unable to obtain necessary medical care. The risk appears to have increased since 1993, when a similar study found the risk of death was 25 percent greater for the uninsured.
How many people died from lack of health insurance in 2010?
Study Found That In 2010, Three Americans Died Every Hour From Lack Of Coverage. According to a June 2012 report from Families USA, “Across the nation, 26,100 people between the ages of 25 and 64 died prematurely due to a lack of health coverage in 2010,” which works out to “three every hour.” The report also found:
What percentage of people who went to Mount Sinai for medical screening did not have health insurance?
Herbert called the findings, which will be published tomorrow in Environmental Health Perspectives, the journal of the National Institute of Environmental Health Sciences, “very worrisome,” especially because 40 percent of those who went to Mount Sinai for medical screening did not have health insurance, and will thus not get proper medical care. [ The New York Times , 9/6/06 ]
How many people have pre-existing conditions?
As many as 82 million Americans with employer-based coverage have a pre-existing condition, ranging from life-threatening illnesses like cancer to chronic conditions like diabetes, asthma, or heart disease. Without the Affordable Care Act, such conditions limit the ability to obtain affordable health insurance if they become self-employed, take a job with a company that does not offer coverage, or experience a change in life circumstance, such as divorce, retirement, or moving to a different state. Older Americans between ages 55 and 64 are at particular risk: 48 to 86 percent of people in that age bracket have some type of pre-existing condition. And 15 to 30 percent of people in perfectly good health today are likely to develop a pre-existing condition over the next eight years, severely limiting their choices without the protections of the Affordable Care Act.
What is a pre-existing condition?
A pre-existing condition is a health condition that exists before someone applies for or enrolls in a new health insurance policy. Insurers generally define what constitutes a pre-existing condition. Some are obvious, like currently having heart disease or cancer.
What are the protections of the Affordable Care Act?
A number of protections have already been put in place by the Affordable Care Act in 2010 and 2011 to increase access to health care coverage for those who need it. Insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying as dependents on their parents coverage up to the age of 26 if they lack access to job-based insurance on their own, and insurers cannot deny coverage to a child because of a pre-existing condition. Thousands of uninsured people with pre-existing conditions have enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan (PCIP), which has already saved peoples lives by covering services like chemotherapy.
How many people lost health insurance in 2009?
Yet, the need for individual market coverage has increased as job-based insurance has decreased. From 2007 to 2009, five million Americans lost employer-sponsored health insurance; the percentage of non-elderly Americans with employer-sponsored insurance dropped from 68 percent in 2000 to 59 percent in 2009. 3 The percentage of small businesses that offer coverage to their employees dropped from 68 percent in 2001 to 59 percent in 2009 although rose in 2010, in part, due to the Affordable Care Acts small business tax credits. 4 Despite the growth in the number of people without employer-sponsored insurance, coverage in the individual market has remained at about 5 percent of non-elderly Americans and declined according to another survey. This is likely due to the increasing unaffordability and unattractiveness of individual insurance products, and to insurers increasing success in screening out applicants with pre-existing conditions. 5
Why are small businesses discriminated against?
People who work in small businesses, along with their employers, may be discriminated against by their insurers due to a pre-existing condition. About 25 percent of people with employer-based coverage are in small group policies. 13 In most States, insurers can engage in experience rating, or take into account the cost of workers or family members with pre-existing conditions within the employer group. As such, workers rates may spike with one workers illness or injury. In addition, small businesses are susceptible to having to scale back or drop coverage when they hire a worker with a pre-existing condition, or when one of their workers gets sick. Small businesses pay on average 18 percent more than large businesses for comparable coverage, in part due to the challenges of covering people with pre-existing conditions. 14
How many people are uninsured under the Affordable Care Act?
Up to one in five non-elderly Americans with a pre-existing condition 25 million individuals is uninsured. Under the Affordable Care Act, starting in 2014, these Americans cannot be denied coverage, be charged significantly higher premiums, be subjected to an extended waiting period, or have their benefits curtailed by insurance companies.
How many people will develop pre-existing conditions in the next eight years?
And 15 to 30 percent of people in perfectly good health today are likely to develop a pre-existing condition over the next eight years, severely limiting their choices without the protections of the Affordable Care Act.
What percentage of pre-existing conditions are declinable?
The rates of declinable pre-existing conditions vary from state to state. On the low end, in Colorado and Minnesota, at least 22% of non-elderly adults have conditions that would likely be declinable if they were to seek coverage in the individual market under pre-ACA underwriting practices.
How many non-neelderly women have preexisting conditions?
A larger share of nonelderly women (30%) than men (24%) have declinable preexisting conditions. We estimate that 22.8 million nonelderly men have a preexisting condition that would have left them uninsurable in the individual market pre-ACA, compared to 29.4 million women. Pregnancy explains part, but not all of the difference.
What is post claim underwriting?
Once enrolled, a person’s health and risk status was sometimes reconsidered in a process called post-claims underwriting. Although our analysis focuses on declinable medication conditions, each of these other actions is described in more detail below.
What happened to Alex's daughter?
Due to time involved in the medical underwriting process, the baby was uninsured for about 2 weeks. A few months later, Jean noticed swelling around the baby’s face and eyes. A specialist diagnosed Alex with a rare congenital disorder that prematurely fused the bones of her skull. Surgery was needed immediately to avoid permanent brain damage. When Jean sought prior-authorization for the $90,000 procedure, the insurer said it would not be covered. Under Arizona law, any condition, including congenital conditions, that existed prior to the coverage effective date, could be considered a pre-existing condition under individual market policies. Alex’s policy excluded coverage for pre-existing conditions for one year. Jean appealed to the state insurance regulator who upheld the insurer’s exclusion as consistent with state law.
How many people were denied health insurance before the ACA?
Prior to the ACA’s coverage expansions, we estimated that 18% of individual market applications were denied. This is an underestimate of the impact of medical underwriting because many people with health conditions did not apply because they knew or were informed by an agent that they would not be accepted. Denial rates ranged from 0% in a handful of states with guaranteed issue to 33% in Kentucky, North Carolina, and Ohio. According to 2008 data from America’s Health Insurance Plans, denial rates ranged from about 5% for children to 29% for adults age 60-64 (again, not accounting for those who did not apply).
How long is a health condition considered pre-existing?
In 19 states, a health condition could only be considered pre-existing if the individual had actually received treatment or medical advice for the condition during a “lookback” period prior to the coverage effective date (from 6 months to 5 years).
What is pre-existing condition exclusion?
In addition to medical screening of applicants before coverage was issued, most individual market policies also included more general pre-existing condition exclusion provisions which limited the policy’s liability for claims (typically within the first year) related to medical conditions that could be determined to exist prior to the coverage taking effect. 3
What happened to preexisting conditions before Obamacare?
What happened to those Americans? Prior to Obamacare, those with preexisting conditions were protected under the federal Health Insurance Portability and Accountability Act (1996), which required states to enact measures to protect such people.
Who conducted an extensive study of the individual market in the pre-Obamacare era?
Wharton economist Mark Pauly and his colleagues conducted an extensive study of the individual market in the pre-Obamacare era. They found that less than 1% of the population was both uninsured and uninsurable because of a preexisting condition.
How did Obamacare affect the individual market?
That skewed the individual market toward a risk pool disproportionately consisting of older, less healthy, and costlier-to-insure individuals. The resulting premium increases then prompted a growing exodus of unsubsidized customers.
Why are Obamacare plans narrow?
The main reason Obamacare plans have narrow networks is to hold down costs. That leads to lower premiums and makes the plans more attractive to buyers—especially buyers who don’t have any health problems. A 2017 study in the journal Health Affairs found premiums for narrow network plans in the exchange were about 16% lower than plans with broader networks.
How many insurers have narrow networks?
One survey, for example, found nearly three-quarters of insurers (72%) feature narrow networks in the plans offered through the federally managed exchanges (HealthCare.gov). This is in stark contrast to 5% to 7% of employer plans that limit worker choices to a narrow network of physicians and hospitals.
What did the Affordable Care Act look like?
When the Affordable Care Act was enacted, many advocates probably imagined it would look like a typical employer plan or a standard Blue Cross individual policy. And in many markets, that’s how it started out.
Why is there a difference in the queue for Medicaid?
This difference is due to Medicaid’s low reimbursements and has persisted over time. It appears that where a patient stands in the queue depends on how generous is the fee paid by his health insurer.
Introduction
Pre-Existing Conditions as A Barrier to Health Care and Coverage
- A “pre-existing condition” is a health condition that exists before someone applies for or enrolls in a new health insurance policy. Insurers generally define what constitutes a pre-existing condition. Some are obvious, like currently having heart disease or cancer. Others are less so – such has having asthma or high blood pressure. While insurers ...
One in Two Americans Has A Pre-Existing Condition
- This new analysis sheds light on the number of Americans gaining protections from discrimination based on pre-existing conditions under the Affordable Care Act. Because pre-existing conditions are determined by insurer practices which vary, two estimates of the number of non-elderly individuals likely to be denied coverage in the individual market were constructed. …
Up to 86 Percent of Older Americans Have A Pre-Existing Condition
- Not surprisingly, as people age, their likelihood of having – or having had – a health condition increases. Looking only at pre-existing conditions used in determining eligibility for high-risk pools, the percentage of Americans with these health conditions ranges from 5 percent of children to 48 percent of people ages 55 to 64. Adding in common conditions that major insurer…