In March, the President signed an historic package of health reforms into law. The new law offers critical protections for the millions of Americans who have pre-existing conditions today—as well as for those who are healthy now but who may develop a health problem as they grow older. As a result of health reform, no American with a pre-existing condition will be denied coverage, charged a higher premium, or sold a policy that excludes coverage of essential health benefits simply because he or she has a pre-existing condition.
This report takes a closer look at the number of Americans with diagnosed pre-existing conditions who, absent reform, would be at risk of being denied coverage in the individual insurance market. The uninsured and those who do not have access to job-based coverage are at greatest risk, but 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. To better understand the effect that health reform will have on these people, Families USA commissioned The Lewin Group to quantify the number of Americans who are diagnosed with conditions that commonly lead to denials of coverage.
Looking only at those serious conditions that are commonly linked to coverage denials, we found that 57.2 million non-elderly Americans have a pre-existing condition that could lead to a denial of coverage in today’s individual insurance market. That’s more than one out of every five people under the age of 65, or 22.4 percent. No group is immune to the effects of this pervasive problem: It affects people in all age groups, every racial and ethnic group, and every income group. All of these people with diagnosed pre-existing conditions are at risk for being denied coverage.
Our analysis does not include every condition that may lead to a denial of coverage, nor does it capture every person with a pre-existing condition that would likely result in higher premiums or excluded benefits. Further, this analysis cannot capture the uninsured and underinsured Americans who, lacking a way to pay for care, do not seek treatment and whose health conditions, therefore, remain undiagnosed. Because people with low incomes and racial and ethnic minorities are disproportionately represented among the uninsured and underinsured, they are likely to be undercounted in our analysis.
The protections that health reform offers mean that every American will now have greater security and peace of mind, knowing that insurance companies will be required to sell health insurance to all individuals regardless of their health status, to charge them the same premiums rather than making them pay more, and to cover all benefits. These new protections mean that every American will always be able to purchase quality, affordable coverage.