According to a Kaiser Family Foundation Study released earlier this week, it says 27% of adult Americans under the age of 65 have health conditions that would likely leave them uninsurable if they applied for individual market coverage under pre-Affordable Care Act (ACA) underwriting practices that existed in nearly all states.
The study shows that the rates of declinable pre-existing conditions vary from state to state, however, in California, the number is 24% or 5,865,000.
In the entire US, the numbers are 27% or 52,240,000.
At any given time, the vast majority of these approximately 52 million people with declinable pre-existing conditions have coverage through an employer or through public programs like Medicaid. The individual market is where people seek health insurance during times in their lives when they lack eligibility for job-based coverage or for public programs such as Medicare and Medicaid. In 2015, about 8% of the non-elderly population had individual market insurance.
Prior to the ACA’s coverage expansions, they estimated that 18% of individual market applications were denied.
Before the ACA, individual market insurers in all but five states maintained lists of so-called declinable medical conditions. People with a current or past diagnosis of one or more listed conditions were automatically denied. Insurer lists varied somewhat from company to company, though with substantial overlap. Some of the commonly listed conditions are shown in Table 2.
| Table 2: Examples of Declinable Conditions In the Medically Underwritten Individual Market, Before the Affordable Care Act | |
| Condition | Condition |
| AIDS/HIV | Lupus |
| Alcohol abuse/ Drug abuse with recent treatment | Mental disorders (severe, e.g. bipolar, eating disorder) |
| Alzheimer’s/dementia | Multiple sclerosis |
| Arthritis (rheumatoid), fibromyalgia, other inflammatory joint disease | Muscular dystrophy |
| Cancer within some period of time (e.g. 10 years, often other than basal skin cancer) | Obesity, severe |
| Cerebral palsy | Organ transplant |
| Congestive heart failure | Paraplegia |
| Coronary artery/heart disease, bypass surgery | Paralysis |
| Crohn’s disease/ ulcerative colitis | Parkinson’s disease |
| Chronic obstructive pulmonary disease (COPD)/emphysema | Pending surgery or hospitalization |
| Diabetes mellitus | Pneumocystic pneumonia |
| Epilepsy | Pregnancy or expectant parent |
| Hemophilia | Sleep apnea |
| Hepatitis (Hep C) | Stroke |
| Kidney disease, renal failure | Transsexualism |
| SOURCE: Kaiser Family Foundation review of field underwriting guidelines from Aetna (GA, PA, and TX), Anthem BCBS (IN, KY, and OH), Assurant, CIGNA, Coventry, Dean Health, Golden Rule, Health Care Services Corporation (BCBS in IL, TX) HealthNet, Humana, United HealthCare, Wisconsin Physician Service. Conditions in this table appeared on declinable conditions list in half or more of guides reviewed. NOTE: Many additional, less-common disorders also appearing on most of the declinable conditions lists were omitted from this table. | |
Some individual market insurers also developed lists of ineligible occupations. These were jobs considered sufficiently high risk that people so employed would be automatically denied. In addition, some would automatically deny applicants who engaged in certain leisure activities and sports. Table 4 provides an example of declinable occupations from one insurer prior to the ACA. Our analysis does not attempt to account for declinable occupations.
| Table 4: Ineligible Occupations, Activities | ||
| Active military personnel | Iron workers | Professional athletes |
| Air traffic controller | Law enforcement/detectives | Sawmill operators |
| Aviation and air transportation | Loggers | Scuba divers |
| Blasters or explosive handlers | Meat packers/processors | Security guards |
| Bodyguards | Mining | Steel metal workers |
| Crop dusters | Nuclear industry workers | Steeplejacks |
| Firefighters/EMTs | Offshore drillers/workers | Strong man competitors |
| Hang gliding | Oil and gas exploration and drilling | Taxi cab drivers |
| Hazardous material handlers | Pilots | Window washers |
| SOURCE: Preferred One Insurance Company Individual and Family Insurance Application Form | ||
For the full study, click here.
Editors Note:
In a worthy read, an article published by the Bay Area NewsGroup’s Tracy Seipel, she highlights how Californian’s with pre-existing conditions are worried about President-elect Donald Trump’s vow to repeal and replace the Affordable Care Act, better known as “Obamacare.”
In another worthy read, an article published in the Wall Street Journal, it highlights how a Kaiser Family Foundation analysis to be released next week found that almost 30% of U.S. adults younger than 65 have health conditions that would have left them uninsurable in a pre-ACA world. Many more people have conditions with which they could still qualify for coverage before ACA protections took effect–but only at premiums they could not afford
