One in Five Americans Is at Risk of a Denial of Coverage

• Approximately 57.2 million Americans under the age of 65 have a pre-existing condition that, absent reform, could lead to a denial of coverage by an insurance company.
• This means that, without health reform, more than one in every five non-elderly Americans (22.4 percent) is at risk of being denied coverage.

Pre-Existing Conditions: A Problem that Grows with Age

• Individuals in every age group are affected by pre-existing conditions that, absent reform, could lead to a denial of coverage. However, those who are older are much more likely to have such a condition, as follows:
  • Nearly one in six young adults aged 18 to 24 (15.9 percent) has a pre-existing condition that could lead to a denial of coverage.
  • More than one-third of adults aged 45 to 54 (35.3 percent) have a pre-existing condition that could lead to a denial of coverage.
  • More than two in five adults aged 55 to 64 (45.5 percent) have a pre-existing condition that could lead to a denial of coverage.
• Adults aged 45 to 64 account for only 28.3 percent of the non-elderly U.S. population, but they make up fully half (50.0 percent) of those with pre-existing conditions.
  • This phenomenon is most pronounced among adults aged 55 to 64. Adults in this age group account for only 11.8 percent of the non-elderly U.S. population, but they make up nearly a quarter (24.0 percent) of those with pre-existing conditions.

Children and Young Adults with Pre-Existing Conditions

• While the percentage of American children and young adults who have a pre-existing condition that could lead to a denial of coverage is low relative to older Americans, a substantial number of children and young adults are affected.
  • Nearly 5.0 million children under the age of 18, and 4.5 million young adults aged 18 to 24, have a pre-existing condition that could lead to a denial of coverage.

Every Income Group Is Affected

• People of every income group have pre-existing conditions that, without health reform, could lead to a denial of coverage (see Table 3). By income group, we see the following trend:
  • The lowest-income Americans are the most likely to have such a condition, with nearly one-quarter (24.2 percent) of individuals in families with incomes below 100 percent of the federal poverty level (less than $22,050 for a family of four in 2010) affected.
  • Approximately 21.9 percent of individuals in families with incomes between 100 and 199 percent of poverty ($22,050-$44,100 for a family of four in 2010) have such a condition.
  • Approximately 22.2 percent of individuals in families with incomes at or above 200 percent of poverty (more than $44,100 for a family of four in 2010) have such a condition.
  • While the lowest-income Americans are slightly more likely to be affected by pre-existing conditions, middle-income and higher-income Americans (those in families earning more than 200 percent of poverty, or $44,100 for a family of four in 2010) make up more than two-thirds (69.8 percent) of those with pre-existing conditions that could lead to a denial of coverage.

Every Racial and Ethnic Group Is Affected

• People of every racial and ethnic group have pre-existing conditions that, absent reform, could lead to a denial of coverage (see Table 4 on page 6). By race and ethnic group, we see the following trend:
  • American Indians and Alaska Natives are the most likely to be affected, with more than one-quarter (25.9 percent) having a pre-existing condition that could lead to a denial of coverage.
  • Approximately one-quarter (24.4 percent) of whites (non-Hispanic) have such a condition.
  • Nearly one-quarter (23.4 percent) of African Americans (non-Hispanic) have such a condition.
    More than one in six Hispanics (16.9 percent) is affected.
  • Slightly fewer than one in six Native Hawaiians and other Pacific Islanders (14.5 percent), and just over one in 10 Asian Americans (11.7 percent), have a pre-existing condition that could lead to a denial of coverage.

Our analysis is based on the number of Americans who are diagnosed with a pre-existing condition that could lead to a denial of coverage. The analysis did not control for disparities in access to care and in the delivery of care that may result in lower rates of diagnosed disease among certain racial and ethnic minority groups. For a more in-depth examination of this point, please see the Discussion below.

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