Reform Law Could Help 57M Americans With Pre-Existing Conditions

An estimated 57 million nonelderly U.S. residents have a diagnosed pre-existing condition that could lead to a denial of individual insurance coverage, according to a recent report by Families USA, CQ HealthBeat reports.

The report notes that all of the 57 million U.S. residents potentially could benefit from a provision in the new health reform law banning insurers from denying coverage to people with such conditions.

The figure does not mean that 57 million U.S. residents currently are being denied coverage, because many currently are enrolled in employer-sponsored health plans rather than in individual insurance plans. Families USA said the figure represents the number of people who could face difficulties in the individual market at some point if the new health reform law is not implemented (Reichard, CQ HealthBeat, 5/6).

Ron Pollack, executive director of Families USA, said the estimate could be low because there might be a significant number of uninsured and underinsured people who have not yet been diagnosed with a pre-existing condition.
The report notes that all age groups are affected by pre-existing conditions that could lead to a denial of coverage, but that the rate increases as people age. Overall, one in six U.S. residents between ages 18 and 24 has a pre-existing condition, while 40% of U.S. residents ages 55 to 64 have pre-existing conditions.

Further, 69.8% of U.S. residents with a pre-existing condition were from families with incomes higher than 200% of the federal poverty level, or $44,100 for a family of four (Lubell, Modern Healthcare, 5/6).
The report seeks to highlight the benefits of the reform law amid criticism by opponents of the overhaul's scope and mandate that individuals buy insurance.

Senate Finance Committee Chair Max Baucus (D-Mont.) said that the report "illustrates what a critical victory the health care reform law is for the 60 million folks with pre-existing conditions."

Robert Zirkelbach, spokesperson for America's Health Insurance Plans, said that insurers support initiatives to eliminate "pre-existing condition exclusions" but that coverage is more affordable and accessible than many people believe. He said an AHIP survey found that nine out of 10 applicants for an individual policy were offered coverage (CQ HealthBeat, 5/6).