Kaiser Family Foundation : Mapping Pre-existing Conditions across the U.S. – Rachel Fehr, Anthony Damico, Larry Levitt Follow @larry_levitt on Twitter , Gary Claxton, Cynthia Cox Follow @cynthiaccox on Twitter , and Karen Pollitz – Published: Aug 28, 2018: “The future of protections for people with pre-existing conditions has once again become a focus of debate following recent legal and policy developments. The Affordable Care Act (ACA) contained a number of new rules related to pre-existing conditions, including:
- Guaranteed access to insurance in the individual market regardless of health. Previously, insurers typically used medical underwriting to deny coverage to people with pre-existing conditions, and also excluded coverage of any pre-existing conditions for people who were accepted.
- Community rating in the individual and small business markets, prohibiting insurers from varying premiums based on people’s health, which was common before the ACA.
- Required coverage of essential benefits. Prior to the ACA, insurers in the individual market often excluded coverage of maternity, mental health, and substance abuse.
Congressional efforts to repeal and replace the ACA during 2017 would have weakened these protections. For example, the bill passed by the House would have allowed states to alter the essential benefit requirement and waive community rating for people with gaps in coverage. The so-called Graham-Cassidy-Heller-Johnson bill drafted in the Senate would have allowed states to determine what factors insurers could use in setting rates, except for gender and genetic information, and also let states change the essential benefits. While those repeal efforts failed, changes pursued by the Trump administration through regulation and the courts have implications for people with pre-existing conditions…Polling by the Kaiser Family Foundation (KFF) finds that 64% of the public does not want the Supreme Court to overturn the ACA’s protections for people with pre-existing conditions, and that continuing those protections tops the list of health issues registered voters say they’ll consider in supporting candidates as the midterm election approaches.
We previously estimated using 2015 data from the Centers for Disease Control and Prevention that 27% of adults age 18-64 (52 million people) have a pre-existing condition that would have led to a denial of insurance in the individual market before the ACA. A larger share of nonelderly women (30%) than men (24%) have declinable preexisting conditions. The share of people with pre-existing conditions also varies by age, ranging from 15% for 18-24 year-olds to 47% for 60-64 year-olds.