Report: One in Five Non-Elderly Californians Has a Diagnosed Pre-Existing Condition

New Report Reveals that Almost 6.5 Million Non-Elderly Californians Will Gain Protections from Health Reform Law Prohibiting Insurance Coverage Denials and Discriminatory Premiums

Washington, D.C.—Approximately 6.5 million people under the age of 65—one in five (20.3 percent) of California’s non-elderly population—have a diagnosed pre-existing condition that could lead to a denial of coverage in the individual health insurance market, according to a report released today by the consumer health organization Families USA. They are among the 57.2 million people nationwide who could potentially face discriminatory health coverage practices.

Once the newly enacted health reform law is implemented, these Californians will gain significant protections: The new law prohibits insurance companies from denying health coverage to people due to pre-existing conditions, charging discriminatory premiums based on health status, and excluding benefits that would treat their health conditions.

The report shows that, while individuals in all age groups in California have pre-existing conditions, this is a problem that grows with age:

• More than one in seven (14.6 percent of) young adults aged 18 to 24 has a diagnosed pre-existing condition that could lead to a denial of coverage.
  
  
• Nearly one-third (33.1 percent) of adults aged 45 to 54 have a diagnosed pre-existing condition that could lead to a denial of coverage.
  
  
• In the 55 to 64 age group, the portion of adults with diagnosed pre-existing conditions climbs to more than two in five (42.3 percent).
  
  
• Although the portion of children under 18 years of age with diagnosed pre-existing conditions is low compared to adults, there are 576,500 children in California with such conditions.

“The millions of Californians with diagnosed conditions, and the many others who at some point may receive such a diagnosis, are the people most in need of health coverage,” said Ron Pollack, Families USA’s Executive Director. “Thankfully, the new health reform legislation will protect all these individuals from the most harmful insurance company abuses that deny such critical coverage.” 

In its analysis, Families USA indicates that the totals may understate how many people nationally and in California have pre-existing conditions, because the analysis reflects only those with diagnosed pre-existing conditions. Americans who are currently uninsured or underinsured and cannot afford care often do not seek treatment, and, as a result, their health condition may not be diagnosed.

The uninsured and those who do not have access to job-based coverage are at greatest risk. However, even those who now have coverage at work could be at risk if they lose or leave their jobs and have to find coverage in the individual market.

Income is no protection against an individual having a pre-existing condition that could lead to a denial of coverage, and the nearly 6.5 million Californians with diagnosed pre-existing conditions come from all income levels.

• The lowest-income Californians are most likely to have a pre-existing condition. More than one in five (21.5 percent) of those individuals in families with incomes below 100 percent of the federal poverty level (less than $22,050 for a family of four) is affected.
  
  
• Approximately 20.0 percent of individuals in California families with incomes between 100 and 199 percent of poverty (between $22,050 and $44,100) are affected.
  
  
• While the lowest-income Californians are slightly more likely to be affected by pre-existing conditions, more than two-thirds (67.1 percent) of those with pre-existing conditions that could lead to a denial of coverage are middle-class and higher-income Americans. These are individuals in families with incomes above 200 percent of poverty, or more than $44,100 for a family of four in 2010.

Individuals in every racial and ethnic group in California have diagnosed pre-existing conditions that, absent reform, could lead to a denial of coverage.

• Approximately one-quarter (24.5 percent) of non-Hispanic whites have pre-existing conditions.
  
  
• Nearly one-quarter (24.3 percent) of African Americans (non-Hispanic) have such a condition.
  
  
• More than one-quarter (28.4 percent) of American Indians and Alaska Natives are affected.
  
  
• Nearly one in five (17.6 percent) Hispanics is affected. It is important to note, however, that disparities in access to care and in the delivery of care may mean that many individuals have a pre-existing condition that has not been diagnosed. For example, previous research shows that at the national level, more than a quarter (25.2 percent) of Hispanic adults had no health care visits in 2007, compared to 14.7 percent of non-Hispanic adults.

“As our study shows, more than one-fifth of the non-elderly population of California will now gain protections that they need to secure affordable health coverage,” said Pollack. “As more and more people learn about these protections, they will no doubt cherish the enactment of health reform.”

The data for the report were based on data on health conditions from the federal Medical Expenditures Panel Survey and demographic data from the U.S. Census Bureau’s Current Population Survey (CPS). Families USA commissioned The Lewin Group to analyze the data. 

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Families USA is the national organization for health care consumers. It is nonprofit and nonpartisan and advocates for high-quality, affordable health care for all Americans.

1201 New York Avenue NW, Suite 1100 · Washington, DC 20005
202-628-3030 · Email: info@familiesusa.org · www.familiesusa.org