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Jan-18-2011 09:52printcomments

New Report: 1.7 Million Oregonians With Pre-Existing Condition Could Be Denied Coverage Without New Health Reform Law

Across the country, up to 129 million would be at risk.

Oregon blooming cherry trees
Photo by Bonnie King

(WASHINGTON D.C.) - Without Affordable Care Act protections, in 2014, 1 in 2 non-elderly Americans could be denied coverage or charged more due to a pre-existing condition.

Health and Human Services Secretary Kathleen Sebelius today released a new analysis showing that, without the Affordable Care Act, up to 1.7 million non-elderly Oregon residents who have some type of pre-existing health condition, like heart disease, high blood pressure, arthritis or cancer, would be at risk of losing health insurance when they need it most, or be denied coverage altogether. Across the country, up to 129 million Americans would be at risk.

Under the full range of policies in the Affordable Care Act to be enacted by 2014, Americans living with pre-existing conditions are free from discrimination and can get the health coverage they need, and families are free from the worry of having their insurance cancelled or capped when a family member gets sick, or going broke because of the medical costs of an accident or disease. Repealing the law would once again leave millions of Americans worrying about whether coverage will be there when they need it. “The Affordable Care Act is stopping insurance companies from discriminating against Americans with pre-existing conditions and is giving us all more freedom and control over our health care decisions,” said Secretary Sebelius. “The new law is already helping to free Americans from the fear that an insurer will drop, limit or cap their coverage when they need it most. And Americans living with pre-existing conditions are being freed from discrimination in order to get the health coverage they need.”

The analysis found that:

  • Anywhere from 50 to 129 million (19 to 50 percent) of Americans under age 65 have some type of pre-existing condition. Examples of what may be considered a pre-existing condition include:
    • Heart disease
    • Cancer
    • Asthma
    • High blood pressure
    • Arthritis
  • Older Americans between ages 55 and 64 are at particular risk; 48 to 86 percent of people in that age bracket live with a pre-existing condition.
  • 15 to 30 percent of people under age 65 in perfectly good health today are likely to develop a pre-existing condition over the next eight years.
  • Up to one in five Americans under age 65 with a pre-existing condition – 25 million individuals – is uninsured.


Prior to the Affordable Care Act, in the vast majority of states, insurance companies in the individual market could deny coverage, charge higher premiums, and/or limit benefits based on pre-existing conditions. Surveys have found that 36 percent of Americans who tried to purchase health insurance directly from an insurance company in the individual insurance market encountered challenges purchasing health insurance for these reasons.

A number of protections are already in place thanks to the Affordable Care Act. Insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying on their parents’ coverage up to the age of 26 if they lack access to job-based insurance of their own, and insurers cannot deny coverage to children because of a pre-existing condition.

Many uninsured Americans with pre-existing conditions have already enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan (PCIP), which provides private insurance to those locked out of the insurance market because of a preexisting condition.

The PCIP program – which has already saved people’s lives by covering services like chemotherapy – serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a preexisting condition.

There is a Pre-existing Condition Insurance Plan available in every State, and more information can be found at www.HealthCare.gov or by calling 1-866-717-5826.

In addition to the ban on discrimination against people with preexisting conditions, in 2014, individuals and small businesses will have access to new, high-quality insurance choices through competitive marketplaces called health insurance Exchanges.

The report can be found at www.HealthCare.gov/center/reports/preexisting.html, and more information about the new protections created by the Affordable Care Act and the Pre-existing Condition Insurance Plan can be found at www.HealthCare.gov.




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Carlos January 19, 2011 9:32 am (Pacific time)

Often it’s not the patient’s fault that he/she has a preexisting condition (although one could argue this in cases of AIDS or lung cancer or cardiovascular disease secondary to smoking). At the same time, it’s not everyone else’s fault, either. Mandating same-cost coverage for preexisting conditions is not insurance. It is, in fact, public welfare, and it could be managed more effectively, efficiently, and affordably independent of the insurance industry that serves most of the population. For example, take any medium-sized corporation that provides health insurance benefits for its employees and their families. This is its “insurance pool.” The insurer evaluates the demographics and calculates the risk, and the corporation arrives at a premium for coverage. Corporations are very good at this. The insurers can usually calculate an appropriate premium to cover all the claims and still make a profit. One of the most important protections under HIPAA is that it helps those with preexisting conditions get health coverage. In the past, some employers’ group health plans limited, or even denied, coverage if a new employee had such a condition before enrolling in the plan. Under HIPAA, that is not allowed. If the plan generally provides coverage but denies benefits to you because you had a condition before your coverage began, then HIPAA applies. . http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html // Providing insurance for those who can’t get coverage due to pre-existing conditions has very few participants. And what’s also being conveniently left out is the difference between the need for coverage and the desire for free coverage. It’s the latter as the saying goes, "the market for free stuff is infinite." This change that congress is voting on today is about making it better for everyone. One cannot create more doctors, staff and medical equipment with the wave a wand, so now that this issue is on the front burner, I believe we now have a chance to create something that would be a model for the world, rather than something designed to be shoved on us by people who never read the bill they voted on. Be patient people.


Luke Easter January 18, 2011 5:09 pm (Pacific time)

Not so my friend. With a 59% increase it has changed for the worse. Make that more worse. And I resent your implications. I love gliding my hands over the smooth polished surface of my doctor's Ferrari and if I get his yard done before the kids come from their most exclusive private school not only do I get a glass (real cyrstal) of lemonade, I can wax the kids limo on the weekends for an extra Alexander Hamilton. Works for me. Okay?


Amanda January 18, 2011 3:13 pm (Pacific time)

The citizens are not enthusiastic about the new Health Care Reform, because the Insurance industry is still calling the shots, without a public option. WHO can afford a 59% premium hike, as alrady announced by Blue Cross and Blue Shield. It is a scam all the way around..Obamacare or not. Nothing has changed.


Mike January 18, 2011 1:37 pm (Pacific time)

Misleading propaganda. Scare Tactics. If this bill comes to maturity your wait for non-existent doctors to treat you will be so far into the future you will soon realize you have been duped. In the meantime all the congressmen will have different coverage, not to mention the waivers that the whitehouse is handing out by the thousands daily. Why? Repealing the bill will allow for the good parts that exist to be used, while revamping other needs, for example: Portability, open states to competition from all available insurance companies, which will drive down prices, tort reform, etc.

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