Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.
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.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)