Prior to passage of the Affordable Care Act, the following are just a few of the pre-existing conditions insurance companies could decline coverage for:
- Alcohol/drug abuse
- Crohn’s disease
- Kidney disease
- Organ transplant
- Parkinson’s disease
- Sleep apnea
A new analysis finds major variations between the estimates of people with pre-existing conditions in U.S. metropolitan areas — even within a state.
Those disparities can be seen in the two Georgia areas studied.
The Kaiser Family Foundation analysis, released this week and based on CDC data, found wide variability when mapping rates of pre-existing conditions across 130 areas in the United States. The national average is 27 percent of adults aged 18 to 64, according to the report. Georgia’s estimate is slightly higher, at 29 percent.
In two specific areas in the state, the analysis found that 23 percent of non-elderly adults in the Atlanta/Sandy Springs/Roswell area have a pre-existing medical condition, but in the Augusta/Richmond County area, the rate is 31 percent.
The findings come as the Affordable Care Act’s protections for people with pre-existing conditions are potentially at risk under a lawsuit filed by 20 states, including Georgia, to overturn the 2010 law.
The Trump administration has filed a brief in the case agreeing with the plaintiffs that the individual mandate, the ACA requirement that people have health coverage, is unconstitutional. The administration also argues that the ACA pre-existing condition protections should be invalidated. Congress voted last year to scrap the individual mandate, and it will end as of 2019.
In a separate move, the White House has expanded the availability of short-term insurance plans, which are exempt from ACA protections such as those for people with pre-existing conditions.
Except for the abolition of the individual mandate, the ACA remains in force. Also known as Obamacare, it prohibits insurers from denying coverage due to a current or past diagnosis of a medical condition, such as cancer, diabetes, stroke or pregnancy. The law also bars health insurers from charging a higher premium based on a person’s health status.
Many people with pre-existing conditions get insurance through an employer or through Medicaid or Medicare, and don’t face any health condition discrimination.
Adults with medical conditions, though, would have trouble getting insurance on the individual market if the ACA is overturned, the Kaiser Foundation analysis says.
Almost two-thirds of U.S. voters — including half of Republicans — say protections of people with health conditions are very important, according to a recent Kaiser Family Foundation poll.
Roselynn Pearson of Peachtree City is an example of a person who’s very appreciative of those protections.
Pearson was diagnosed with endometrial cancer in 2011. Prior to that, she was uninsured because, she says, the premiums for insurance were approaching that of a mortgage for a self-employed person. Her choice was between “a roof over my head or insurance,” she said Wednesday.
After her diagnosis, Pearson was able to get ACA coverage and care.
“For everyone with a diagnosis like cancer, having affordable, available coverage is a godsend and lifesaving,” she said.
Now 66, Pearson has Medicare coverage — and has “no evidence” of cancer.
Women’s rate higher than men’s
The share of non-elderly adults with a pre-existing condition ranges from one-third or more in some states (Kentucky, Alabama, Mississippi and West Virginia) to 23 percent or less elsewhere (Alaska, District of Columbia, New Jersey, Utah, Colorado, and Minnesota), the Kaiser report said.
The share of people with pre-existing conditions also varies by age, ranging from 15 percent for 18- to 24-year-olds to 47 percent for 60- to 64-year-olds. Women have a higher rate than men, 30 percent to 24 percent, according to the Kaiser report.
The Commonwealth Fund said Wednesday that before the ACA, many insurers maintained lists of up to 400 different conditions that would potentially disqualify applicants from insurance or result in their being charged higher premiums. As many as 35 percent of people who tried to buy insurance on their own were turned down by an insurer, were charged a higher premium, or had a benefit excluded from coverage due to a pre-existing health problem, the report said.
Some states (though not Georgia) have incorporated the ACA’s protections on consumers with health conditions into their state laws, the Commonwealth Fund reported.
The pre-existing condition protections are a central focus of the 20-state lawsuit against the ACA.
Georgia Attorney General Chris Carr says the state’s participation in the Texas-based lawsuit stems from his conclusion that the 2010 health care law is unconstitutional. Previous court challenges to the ACA have failed, but the legal reasoning of the latest suit is somewhat different from past ones.
In a recent Marietta Daily Journal editorial, Carr called the ACA “a terribly flawed law that has left Georgians with skyrocketing insurance premiums and dwindling access to health care.
“Americans deserve a health care law that is constitutional and that delivers more access and more affordable choices,” Carr wrote. “We can do both.”
A spokeswoman for Carr said Wednesday that the attorney general supports protections for those with health conditions. “Ultimately, however, he recognizes that the federal and state legislatures and private sector will be responsible for determining what would replace the ACA,” said the spokeswoman, Katie Byrd.
Last Friday, 10 Republican senators introduced a bill to preserve the ACA provisions that keep people with pre-existing conditions from being denied coverage or charged more, as a backstop in case the GOP-led lawsuit against the law succeeds, The Hill reported.
Sen. Susan Collins (R-Maine) says she does not support the bill to enshrine pre-existing condition protections because it doesn’t include other key Obamacare consumer protections, the Washington Examiner reported.