Many Americans have health-related problems that are defined as pre-existing conditions. A pre-existing condition is a health problem that existed before you apply for a health insurance policy or enroll in a new health plan.
A pre-existing condition can be something as common and as serious as heart disease, high blood pressure, cancer, diabetes and asthma – chronic health problems that affect a large portion of the population. Even if you have a relatively minor condition such as hay fever or a previous accidental injury, a health plan can deny coverage.
Insurers are concerned about keeping their costs low – it’s in their best interest, therefore, to exclude coverage for people with pre-existing conditions, impose a waiting period before coverage starts, or charge higher premiums and out-of-pocket expenses.
It may be in the economic interest of insurers, but it is not in the interest of those with serious health issues.
One of the important changes from the federal health care reform law was the elimination of pre-existing condition requirements imposed by insurers.
The federal law phases in the ban. As of September 2010, insurers could not deny coverage to children with pre-existing conditions. Starting in 2014, this provision will apply to adults as well.
According to a report released by Families USA last week, that change will help a lot of people. The report found that nearly 65million Americans under the age of 65 have been diagnosed with pre-existing conditions that, without health reform, could lead to denials of coverage in the individual health insurance market.
In other words, without health reform, one in four non-elderly Americans is at risk of being denied coverage.
Not surprisingly, those who are older are much more likely to have such a condition. The report found:
· One in five young adults aged 18 to 24 has a pre-existing condition that could lead to a denial of coverage.
· Nearly two in five (37.2 percent of) adults aged 45 to 54 have a pre-existing condition that could result in a denial of coverage.
· Nearly half (47.8 percent) of adults aged 55 to 64 have a pre-existing condition that could lead to a denial of coverage.
Adults aged 45 to 64 account for less than 30 percent of the non-elderly population, but they make up nearly half of those with pre-existing conditions.
The report found little difference in the likelihood of pre-existing conditions among income groups or racial and ethnic groups.
The bottom line – age is the biggest factor in whether one has a pre-existing condition.
For those over the age of 65, while having a pre-existing condition can be a serious health issue, it is unlikely to be a serious financial problem. After all, those over the age of 65 have universal coverage issued by the federal government – Medicare.
As the campaign season heats up, it has become an article of faith among opponents of the new law that the entire health care reform law must be repealed. But to do so will put as many as 65 million Americans at risk.
And those with serious pre-existing conditions – like cancer – face the most serious risk: not being able to get health insurance at all.
During the political season issues often get distorted beyond all recognition. That is clearly the case of the federal health care reform.
When you hear people say that the federal reform must be repealed, ask them about the 65 million Americans with pre-existing conditions. What will happen to them?
Blair Horner is the Vice President for Advocacy for the American Cancer Society, Eastern Division. His commentary does not necessarily reflect the views of the American Cancer Society.
The views expressed by commentators are solely those of the authors, and do not necessarily reflect the views of this station or its management.