HHS: Coverage of Americans with preexisting conditions up since ACA

Dive Brief:

  • Between 2010 and 2014, the number of Americans with preexisting conditions who lacked health insurance dropped by 22%, or 3.6 million people, thanks to reforms implemented under the ACA, a new analysis by HHS’ Assistant Secretary for Planning and Evaluation finds.
  • ASPE says the uninsured rate for all Americans fell a further 22% through the middle of last year and it’s likely there would be similar results for the population with preexisting conditions.
  • Before the ACA, people with preexisting conditions were frequently turned away by insurers or forced to pay higher rates to obtain coverage.

Dive Insight:

Just over half (51%) of nonelderly Americans — or 133 million individuals — have a preexisting medical condition, according to the analysis. That estimate is based on the definition payers used for underwriting purposes prior to the ACA. The most common preexisting conditions are hypertension (46 million), behavioral health disorders (45 million), asthma or chronic lung disease (34 million), heart conditions of heart disease (16 million), diabetes (13 million) and cancer (11 million), the analysis says.

A recent Kaiser Family Foundation analysis revealed estimated numbers and percents of nonelderly Americans in each state that would likely be turned away by insurers because of their pre-existing conditions. 

The ACA requires insurers in the individual market to offer the same comprehensive coverage to people with preexisting coverage that is offered to healthy individuals. To ensure a balanced risk pool and keep costs affordable, the healthcare law provides subsidies for low-income households and taxes people who can afford coverage but choose to forego it.

That could all change as Republicans in the House are already working to repeal parts of the ACA. With no viable alternative plan in the offing, it’s unclear whether the ban on insurers discriminating against people with preexisting conditions will survive the chopping block.

Filed Under: Payer Health Law Policy & Regulation
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