Report: More than One in Five Non-Elderly New Mexicans Has a Diagnosed Pre-Existing Condition

New Report Reveals that 380,000 Non-Elderly New Mexicans Will Gain Protections from Health Reform Law Prohibiting Insurance Coverage Denials and Discriminatory Premiums

Washington, D.C.—Approximately 380,000 people under the age of 65—more than one in five (22.8 percent) of New Mexico’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 New Mexicans 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 from excluding benefits that would treat their health conditions.

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

• Nearly one in six (16.6 percent of) young adults aged 18 to 24 has a diagnosed pre-existing condition that could lead to a denial of coverage.
  
  
• More than one-third (34.7 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 nearly half (45.9 percent).
  
  
• Although the portion of children under 18 years of age with diagnosed pre-existing conditions is low compared to adults, there are 36,400 children in New Mexico with such conditions.

“The thousands of New Mexicans 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 New Mexico 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 380,000 New Mexicans with diagnosed pre-existing conditions come from all income levels.

• Nearly one-quarter (23.1 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) are affected.
  
  
• Approximately 23.1 percent of individuals in New Mexico families with incomes between 100 and 199 percent of poverty (between $22,050 and $44,100) are affected.
  
  
• Of special note, nearly two-thirds (62.3 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 New Mexico have diagnosed pre-existing conditions that, absent reform, could lead to a denial of coverage.

• More than one-quarter (25.9 percent) of non-Hispanic whites have pre-existing conditions.
  
  
• Nearly one in three (30.3 percent of) African Americans (non-Hispanic) has such a condition.
  
  
• Nearly one-quarter (24.3 percent) American Indians and Alaska Natives are affected.
  
  
• Nearly one in five (19.4 percent of) 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 New Mexico 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