Fact

As many as 1 in 2 Americans has a preexisting condition.

Do 1 in 2 Americans Really Have a Preexisting Health Condition?

Studies have shown that as many as 1 in 2 Americans have a health condition that qualifies as a pre-existing condition. While 1 in 2 is on the high side of a 2011 estimate done by HHS, it is generally accurate.

TIP: See a list of preexisting conditions that affect life insurance. It is a mind-numbingly long list that includes every condition under the sun. This is what is at stake if the ACA repealed. The only loophole under the old system was to go work for a large employer (as they could provide guaranteed coverage). So if you think being forced to work for a large employer until you turn 65 is a good thing then support a full ACA repeal, if you think it isn’t, consider learning about our fix.

See how this video describes this period in which they can deny you coverage and care? Yeah, that is how it used to be for 1 in 2 Americans before the ACA… and new repeal and replace plans are set to bring this back!

FACT: Before the Affordable Care Act nearly 1 in 5 Americans with preexisting condition was uninsured. As of December 2016, the total uninsured rate is at an all-time low of less than 10%.

FACT: A 2007 study found that about 36% of American surveyed had been turned down or charged a higher price due to preexisting conditions and 85 percent of adults with incomes under 200 percent of poverty who tried to buy coverage on the individual market never purchased it. When people point out that coverage used to be cheaper before the ACA, they typically don’t tell this part of the story.[1]

What Qualifies as a Preexisting Condition?

More specifically, according to a 2011 HHS report, anywhere from 50 to 129 million (19 to 50 percent) of Americans under age 65 have some type of pre-existing condition. Meanwhile, 48 to 86 percent of people ages 55 to 64 live with a pre-existing condition. Meanwhile, many seniors over 65 live with a preexisting condition.[2]

So, the number is a range based on studies, the number doesn’t include those under 18 (of which less have a preexisting) or those over 65 (of which more have a preexisting). Instead, this range is given as an idea of how as many as 50% of those affected by the Affordable Care Act benefited from its patient protections.

The exact numbers depend on what we consider a preexisting condition and survey data, but the general factoid is true.

While preexisting conditions include things like “having hey fever once”, and thus one’s first thought might be “well if we are going to count every little thing, then of course 50% of people have a preexisting” it must be noted that this is exactly the sort of thing insurers do when assessing the insurability and rate of a person requesting a healthcare contract… or at least that was the case before the Affordable Care Act. Under the Affordable Care Act no one can be charged more, denied coverage, or dropped from coverage for having a preexisting condition.

Thus, in the current environment it may seem like preexisting conditions don’t matter much, but it sure used to and it could again if the ACA is repealed. Thus, it is important for Americans to understand that very roughly half of them have some sort of health condition that technically counts as “a preexisting condition”.

FACT: The study: At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: 129 Million People Could Be Denied Affordable Coverage Without Health Reform lists off a large number of citations that back up the general claims made about 1 in 2 Americans having a preexisting. When you dig in you realize

This video lists off some of the many health conditions that count as a preexisting condition.

FACT: The data is sometimes used to make it seem like “120 million lives were saved because of the ACA”… it doesn’t work like that. The real “at risk” demographic where those who don’t work for large companies, those who have been sick in the past, and those who don’t live in states that had strict preexisting conditions rules. Still, when we consider a person’s full life span, the chances that they will fall in a category increases dramatically and starts to resemble the 1 in 2 phrasing a lot more accurately. [3]

Preexisting Conditions and the Affordable Care Act

Luckily, the Affordable Care Act (ACA) ensures guaranteed issue coverage for preexisting conditions. This means that, under the ACA, the 1 in 2 who could have been charged more for coverage before the law due to having been sick in the past, can’t be today (although proposed GOP repeal and replace plans change this via a “Continuous Coverage Exclusion” For Pre-Existing Conditions; so this may change in the future).[4][5][6]

The ACA isn’t all good, but the preexisting conditions provision protects about half of America.



Conclusion

While it isn’t accurate to say “exactly 50% of Americans have a preexisting condition” (as the definition of a preexisting condition and the exact health status of all Americans isn’t something easily defined), general statements like “as many as 1 in 2 Americans have a preexisting condition” or “about 1 in 2 Americans have a preexisting condition” are accurate enough and can be backed up by past surveys and studies.

The point here isn’t that the ACA magically saved 120 million lives, it is that about 1 in 2 Americans have a health condition that could be considered a preexisting condition, which (even with large employer coverage and other avenues that people used to use to skirt the issue considered) should be kept in mind in a push to repeal the Affordable Care Act.


Citations

  1. Failure to Protect: Why the Individual Insurance Market Is Not a Viable Option for Most U.S. Families Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007
  2. At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: 129 Million People Could Be Denied Affordable Coverage Without Health Reform
  3. Millions with Preexisting Conditions
  4. The “Continuous Coverage Exclusion” For Pre-Existing Conditions
  5. The “Continuous Coverage Exclusion” For Pre-Existing Conditions
  6. Guaranteed Issue


"As Many As 1 in 2 Americans Have a Preexisting Condition" is tagged with: Morality, Mortality Rates


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