HHS Report Says Nearly Half of Americans Have Conditions That Could Limit Coverage

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A day before House Republicans were scheduled to vote on repealing the health care reform law, the Department of Health and Human Services Jan. 18 released an analysis finding that as many as 129 million Americans under the age of 65 have a pre-existing health condition that could put them at risk for losing health insurance or being denied coverage.

The report “shows why the repeal would be a huge mistake,” Department of Health and Human Services Secretary Kathleen Sebelius said during a telephone press conference. “Almost half of our population age 64 and younger could be discriminated against based on their pre-existing health condition,” she said.

“Thanks to the protections in the [Patient Protection and Affordable Care Act (PPACA)], by 2014 those citizens will have the freedom and security that comes with having quality, affordable health coverage,” Sebelius said.

The study found that 50 million people have serious health conditions and would qualify to join a high-risk pool insurance plan operated by states, Sebelius said during a question-and-answer session. So far, about 10,000 people have joined the Pre-Existing Condition Insurance Plan program. It was begun separately from the state high-risk pool plans under PPACA to provide short-term coverage to those currently denied coverage due to pre-existing conditions. Under PPACA, insurers are barred from denying coverage based on pre-existing conditions in 2014, she said.

As many as 82 million Americans who have health insurance through their employers have pre-existing conditions, such as cancer, diabetes, asthma, or heart disease, the report said. “Without the Affordable Care Act, such conditions limit the ability to obtain affordable health insurance if they [individuals] become self-employed, take a job with a company that does not offer coverage, or experience a change in life circumstance, such as divorce, retirement, or moving to a different state,” said the report, At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: 129 Million People Could Be Denied Affordable Coverage Without Health Reform.

The percentage of people with pre-existing conditions varies by insurance status, with the highest rates among those with employer-sponsored insurance, between 21 percent to 54 percent, the HHS report said. “Pre-existing conditions matter less for people insured through employers that have a large risk pool and can therefore spread the cost of workers' illnesses or injuries,” it said. Further, some insurance protections already exist for people changing jobs, it said.

“However, 32 [million] to 82 million people with both health problems and job-based coverage would be vulnerable without the new law,” the report said. Employers increasingly are using annual and lifetime limits on benefits to keep their health insurance costs down, and about 94 million Americans were in employer-sponsored insurance with a lifetime limit in 2009, it said. PPACA bans lifetime limits in private insurance and the law has restricted annual limits for group and new individual market plans before banning annual limits in 2014, it said.

At the press briefing, several citizens described their difficulties trying to maintain health insurance for themselves and their children after they developed health problems.


Responding to HHS's analysis, Michael Steel, spokesman for House Speaker John Boehner (R-Ohio), told BNA in an e-mail: “Washington Democrats have a talking point about pre-existing conditions--not a solution. The new health care law raises taxes on the chronically ill and its high-risk pools are so badly under-funded that nearly half of the states have opted out. We need to repeal the law and start over with solutions that help states expand their high-risk pools and lower costs for all Americans, including those with pre-existing conditions.”

Robert Zirkelbach, spokesman for America's Health Insurance Plans, told BNA, “We have long agreed that the individual insurance market needs to be reformed, but this report significantly exaggerates the number of people whose coverage is impacted by pre-existing conditions.” AHIP represents about 1,300 health insurance companies that cover about 200 million people.

Most people get their health insurance coverage through their employer, which does not take into account pre-existing conditions, Zirkelbach said. In addition, nine out of 10 people who apply for coverage in the individual market are offered a policy, and many other people are eligible for public programs such as Medicaid, he said.

By Sara Hansard

At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: 129 Million People Could Be Denied Affordable Coverage Without Health Reform is available at http://www.healthcare.gov/center/reports/preexisting.html.

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