Pre-Existing Conditions Affect One and All
Pre-Existing Conditions Affect One and All
Why We Need to Put an End to Medical Underwriting
by Tanya Feke, MD
I have a pre-existing medical condition.
Odds are you do, too, and if you don’t, you know someone who does.
Pre-existing conditions affect us all one way or another. It doesn’t matter how old you are. It doesn’t matter how healthy you look.
The Center for Consumer Information & Insurance Oversight, a division of the Centers for Medicare and Medicaid Services, estimated that 50 percent of Americans had a pre-existing medical condition in 2011. They went on to report that without healthcare reform, as many as 129 million people could be denied access to health care.
This was before the Affordable Care Act, aka Obamacare, passed in 2010. As of 2014, medical underwriters could no longer use your medical history to charge you more for coverage, and they certainly could no longer deny you coverage altogether. As a result, millions of people who had been denied coverage in the past finally gained access to health insurance.
That may be about to change thanks to the U.S. House of Representatives passing the American Health Care Act (AHCA) on May 4, 2017. The ACHA may put pre-existing conditions back on the table, but only if the Senate also passes the bill.
What Are Pre-Existing Conditions?
Having a pre-existing condition means that you have a medical problem before you start up on a new health plan. Before the Affordable Care Act, private insurers could use a process called medical underwriting to decide whether or not you qualified for coverage. They could charge you more for having certain conditions, could decrease your coverage for having those conditions, and even had lists of conditions that would immediately disqualify you from getting any coverage at all.
A review of insurance literature by the Henry J. Kaiser Family Foundation shows that some of these declinable conditions included: AIDS/HIV, alcohol abuse, Alzheimer’s disease, bipolar disorder, cancer, cerebral palsy, chronic obstructive pulmonary disease (COPD), congestive heart failure, coronary artery disease with or without bypass surgery, Crohn’s disease, drug abuse, depression (severe), diabetes, eating disorders, emphysema, epilepsy, fibromyalgia, hemophilia, hepatitis, kidney disease, lupus, multiple sclerosis, muscular dystrophy, obesity (severe), organ transplant, paraplegia, paralysis, Parkinson’s disease, post-traumatic stress disorder, pregnancy, rheumatoid arthritis, sleep apnea, stroke, transsexualism, and ulcerative colitis.
Many people have been denied health insurance for simply having these conditions documented in their medical record, at least before Obamacare.
Note: Despite the social media outrage, domestic violence and rape were never officially included on any of the declinable pre-existing medical lists, although many of the terrible complications from these atrocities, e.g., mental health disorders, would qualify as a pre-existing condition.
How Many People Have Declinable Pre-Existing Conditions?
Everyone hates fake news, so let’s take a look at some very real statistics gathered by the U.S. government.
The National Diabetes Statistics Report in 2014 noted 17.7 million Americans under 65 years old had diabetes in 2011.
According to the Centers for Disease Control and Prevention, more than 232,000 people (rounded to the nearest thousand) were diagnosed with breast cancer, 212,000 with lung cancer, 176,000 with prostate cancer, 131,000 with colon cancer, 71,000 with skin cancer, 70,000 with bladder cancer, 56,000 with kidney cancer, 50,000 with uterine cancer, 21,000 with liver cancer, 20,000 with ovarian cancer, and 11,000 with cervical cancer in 2013. That reflects only the new cases. When you count those still undergoing treatment and you consider cancer survivors, the numbers grow exponentially.
When it comes to cardiovascular disease, 5.7 million Americans had heart failure in 2013. 750,000 people have a heart attack and 795,000 have a stroke every year.
4.9 million Americans had kidney disease in 2014.
7.6% of the Americans over 12 years old suffers from depression at any given time.
36% of American adults are obese.
I could go on …
Pre-Existing Conditions Are Not Anyone’s Fault
Perhaps one of the most painful things about having a pre-existing condition is the blame and shame often associated with it. Too many people are blamed for things out of their control.
You hear Representative Mo Brooks (R-Ala) say that people with pre-existing conditions should “contribute more to the insurance pool” to offset the cost “to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy.”
People with pre-existing conditions do not lead healthy lives?
Then there are the Twitter comments from former Representative Joe Walsh (R-Ill): “Sorry Jimmy Kimmel: your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care,” after television host Jimmy Kimmel publicly spoke about his newborn son being born with a congenital heart condition. Kimmel’s son had to undergo life-saving heart surgery in his first days of life.
Children should be punished for being born?
Why We Need to Get Rid of Pre-Existing Conditions
These sorts of judgments show more than a lack of compassion. They show lack of a moral compass.
They also show a lack of understanding for how health insurance works. People pay into a health plan, not because those dollars are going to be put aside for them. They pay so that when they need care, they can get care. In the meantime, those dollars are used for other people who need care now. So I hate to tell you, Representative Walsh, but you are ALWAYS paying for someone else’s health care.
No matter how well someone treats their body, no matter how well they eat or how much they exercise, they are not exempt from getting sick. We are born with the genes our parents gave us, and some of those genes may increase our risk for certain medical conditions. We live in environments that could expose us to different chemicals and toxins. Some people cannot afford food or basic needs. Accidents happen, leading to unexpected injuries. People are abused and traumatized. The world is not always kind.
People should not be punished for their life circumstances.
To put a price on their misfortune is the lowest form of depravity.
Center for Consumer Information & Insurance Oversight, Centers for Medicare and Medicaid Services. At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans. https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/preexisting.html. Published 2011.
Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014. https://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf.
Claxton G, Cynthia Cox C, Damico A, Levitt L, Karen Pollitz K. Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA. The Henry J. Kaiser Family Foundation website. http://kff.org/health-reform/issue-brief/pre-existing-conditions-and-medical-underwriting-in-the-individual-insurance-market-prior-to-the-aca/. Published December 12, 2016.
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. Statistics for Different Kinds of Cancer. https://www.cdc.gov/cancer/dcpc/data/types.htm. Updated April 16, 2016.
Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention. Heart Failure Fact Sheet. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm. Updated June 16, 2016.
Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention. Know the Signs and Symptoms of a Heart Attack. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heartattack.htm. Updated June 16, 2016.
Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention. Stroke Fact Sheet. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_stroke.htm. Updated June 16, 2016.
Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion. https://www.cdc.gov/obesity/data/adult.html. Updated September 1, 2016.
National Center for Health Statistics, Centers for Disease Control and Prevention. Depression. https://www.cdc.gov/nchs/fastats/depression.htm. Updated October 6, 2016.
National Center for Health Statistics, Centers for Disease Control and Prevention. Kidney Disease. https://www.cdc.gov/nchs/fastats/kidney-disease.htm#. Updated March 30, 2017.