Study: 52 Million Have Conditions Insurers Used To Deny Coverage Pre-ACA

UNITED STATES - JUNE 25: Affordable Care Act supporters hold up signs outside the Supreme Court as they wait for the court's decision on Obamacare on Thursday, June 25, 2015. (Photo By Bill Clark/CQ Roll Call) (CQ Ro... UNITED STATES - JUNE 25: Affordable Care Act supporters hold up signs outside the Supreme Court as they wait for the court's decision on Obamacare on Thursday, June 25, 2015. (Photo By Bill Clark/CQ Roll Call) (CQ Roll Call via AP Images) MORE LESS
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A new study finds that 52 million non-elderly Americans have the sort of pre-existing conditions insurers cited to deny them health insurance coverage in the pre-Affordable Care Act world. The study, released Monday by the Kaiser Family Foundation, notes that a majority of those Americans are covered by group health plans where they would not face such medical underwriting. But it adds that, due to market churn, many more than just the 8 percent or so of consumers who currently receive coverage through the individual marketplace stand to be affected if the pre-existing conditions provision of Obamacare is dismantled.

“For many people, the need for individual market coverage is intermittent, for example, following a 26th birthday, job loss, or divorce that ends eligibility for group plan coverage, until they again become eligible for group or public coverage,” the study said.

Exactly what conditions insurers could cite to deny Americans coverage varied state-by-state before the the ACA’s pre-existing conditions provisions was fully implemented in 2014. In some states, like Minnesota, an estimated 22 percent of the population had conditions that insurers could use to deny them coverage. In others, like West Virginia, the potentially uninsurable made up 36 percent of the non-elderly population. Overall, about 27 percent of Americans have the pre-existing conditions insurers could use to deny them coverage.

A vast majority of states had lists, pre-ACA, of deniable conditions, which commonly included maladies ranging from cancer and kidney disease to mental disorders and sleep apnea.

Additionally, some insurers could deny coverage on the basis of consumers’ occupation, including coal miners, meat processor, firefighters, security guards, pilots and taxi cab drivers.

The study notes that, in addition to denying people coverage entirely on the basis of pre-existing conditions, insurers before Obamacare could use other tactics to discriminate against those consumers. For instance, some consumers faced exclusion riders, which would exempt treatment for specific conditions or for particular body parts from their coverage. Others were only covered with a surcharge on premiums, or faced higher deductibles.

Pre-existing conditions coverage is a provision of Obamacare that some Republicans, including President-elect Donald Trump, have said they would like to preserve in an eventual GOP replacement for Obamacare. Other Republicans have proposed using a continuous coverage standard instead, which would prohibit insurers from discriminating on the basis of pre-existing conditions only if the consumer maintains continuous coverage.

If Republicans move forward with repealing Obamacare via the legislative maneuver known as reconciliation — akin to the repeal bill lawmakers passed but President Obama vetoed in January — then Obamacare’s pre-existing conditions would remain in effect, at least during the transition phase into a to-be-determined ACA alternative. Health policy experts have warned, however, that keeping the pre-existing conditions provision on the books without the ACA’s individual mandate, which could be repealed right away, risks major chaos in the individual markets.

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  1. Being covered by an employer group plan would not guarantee coverage of a pre-existing condition if that provision of the ACA is dismantled. Yes, one might be covered for other medical concerns, but not for the pre-existing condition. BTW, this might include a pregnancy, rehab from some sort of surgery, etc., not just a chronic condition.

  2. Avatar for marby marby says:

    Those 52 million Americans are clearly just collateral damage to the GOP in their desire to take one final swipe at any policy of President Obama.

  3. Avatar for dbutch dbutch says:

    Prior to ACA, all the employers I’ve worked for either explicitly negotiated coverage of pre-existing conditions as part of the contract with health insurers or paid directly for the coverage, using the insurers mainly as a management agency.

  4. And probably a lot more folks will get kicked off than got on because now that they have been getting treatments it will be on record.

    Ending Obamacare with nothing else is going to be a massive disaster for folks. Republican voters may be too dumb to realise this, but how can Republican politicians be this dumb?

  5. When it comes to Republicans you need to reverse the old saying on malice/stupidity, with Republicans it is “never ascribe to stupidity what can be ascribed to malice.”

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