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Health Care Reform:

Health Insurance & Affordable Care Act

Voter Guide: Pre-existing Conditions

The Issue:

Today, if you who buy health insurance on the private insurance market rather than getting it through your job, you could be denied coverage because of your medical history or health status.

Insurance companies review the age, gender, and health history of everyone who applies for health insurance. If an insurer believes paying for your health care is likely to be very expensive because of an existing medical condition, there’s a good chance you’ll be denied coverage. In some cases, insurers will sell you a health plan but exclude coverage for the very condition for which you most need insurance.

A recent report by the United States Government Accountability Office (GAO) found that 36 million to 122 million adults ages 19-64 reported having a medical condition, such as high blood pressure, that today could cause insurers to deny their application for health insurance. That's 20% to 66% of U.S. adults.

Proposals:

Coverage Starting in 2014

When the health reform law takes full effect on Jan. 1, 2014, insurers will no longer be able to deny coverage to people with pre-existing medical conditions. Insurers will also be banned from raising the cost of insurance premiums or restricting benefits to anyone because of their health status.

In 2014, millions of Americans who buy health insurance on their own will, for the first time, be guaranteed coverage no matter the state of their health.

Coverage for Children

Children younger than 19 already have these protections under the Affordable Care Act. Beginning Sept. 23, 2010, insurance companies were no longer allowed to deny children with pre-existing health conditions coverage.

There is also a government program in place for adults with medical conditions that make it difficult for them to buy health insurance. It's called the Pre-Existing Condition Insurance Program (PCIP), and it allows people who are denied insurance to buy coverage at a reasonable rate. This program will no longer be in place after 2014 when the full law takes effect.

Repealing the Affordable Care Act

If the Affordable Care Act is repealed, it is not clear what options those with pre-existing conditions would have going forward. Under current law, people who have pre-existing conditions cannot be denied insurance as long as they have maintained continuous coverage, for instance if they move from one job to another.

For those without insurance, one option is to let the states decide how to cover people with pre-existing conditions. 

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