Politics

You Might Have a 'Pre-Existing Condition' and Not Even Know It

January 27th 2017

By:
Danielle DeCourcey

The Affordable Care Act, commonly known as Obamacare, is on the verge of being repealed by Republicans in Congress, with the support of President Donald Trump, and much of the national discussion concerns what that will mean for millions of people with pre-existing conditions. 

Some might think this conversation only concerns older people, or not even know what a pre-existing condition is. But pre-existing conditions, which insurers are currently required to cover under Obamacare, affect young people too, not just the elderly — and not just people with serious illnesses. 

What is a pre-existing condition? 

patient-sitting-on-doctors-table

A pre-existing condition is a health condition someone has before getting a new insurance policy. Before the ACA, insurance companies in the individual market (rather than group insurance plans from an employer) could use a person's medical history to determine whether they would cover the person at all, or use it to raise the price of coverage.

doctor

"They would put them into a 'high risk pool,' which meant they could get insurance, but it would cost them thousands of dollars a month," Trisha Torrey, founder of the industry group The Alliance for Professional Health Advocates, told ATTN:.  

The ACA rollout in 2013 put protections in place that stopped that practice. 

The Kaiser Family Foundation estimates that more than a quarter of adults under 65 with pre-existing conditions would be left "uninsurable."

Pre-existing conditions can be chronic common ailments, not just serious illnesses. 

doctor's office

ATTN: reported on Jan. 24 that Minnesota lawmakers have already proposed legislation that, if the ACA is repealed, would allow insurers to deny coverage to people with pre-existing conditions and refuse to provide services like maternity benefits, addiction treatment, and care for mental health issues. 


"We did a study before the ACA went into affect and what we found was only 12 percent of individual plans across the country covered maternity care in the individual market," Gretchen Borchelt, vice president for reproductive rights and health at the National Women’s Law Center, told ATTN: She said that even pregnancy (and Caesarean sections) could be considered pre-existing conditions. 

These type of exclusions are not new. Before the ACA, a wide range of conditions could exclude people from coverage or make their premiums higher depending on state laws. An Illinois Blue Cross Blue Shield rejections list for pre-existing conditions, published in 2012, listed drug abuse, HIV, and bi-polar disorder as conditions that would cause people to "most likely be declined for individual coverage."

Rejections list for individual coverage.

Torrey said she's watching and waiting to see what lawmakers will do.

"They say they will make sure people with pre-existing conditions will be able to get insurance, but no one says how much it will cost," she said. "We don’t know how Trump and the new Congress will change any of it."

RELATED: This State Just Showed What Insurance Without Obamacare Might Look Like