Home » As Many As 1 in 2 Americans Have a Preexisting Condition
As Many As 1 in 2 Americans Have a Preexisting Condition
Researched by Thomas DeMichelePublished - December 12, 2016 Last Updated - October 10, 2017
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. Studies done since have generally drawn the same conclusions (see links and citations below).
TIP: See a list of preexisting conditions that affect life insurance. It is a mind-numbingly long list that includes just about every condition under the sun. This is what is at stake if the ACA repealed (although one should note many states had state-based rules that protected those with preexisting conditions before the law). The only loophole under the old system, for those in states without protections, 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 something you want, consider learning about our fix.
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.
According to a 2011 HHS report, anywhere from 50 to 129 million (19 to 50 percent) of Americans under age 65 have a preexisting condition. Meanwhile, 48 to 86 percent of people ages 55 to 64 live with a preexisting condition. Many seniors over 65 live with a preexisting condition.
The number is a range based on studies; the number doesn’t include those under 18 (a group in which fewer people have preexisting conditions) or those over 65 (a group in which more people have preexisting conditions). Instead, this range tells us that 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.
Preexisting conditions include minor things like “having hay fever once.” Thus, one’s first thought might be dismissive. “If we are going to count every little thing, then of course 50% of people have a preexisting condition.” However, this is exactly the sort of reasoning that insurers used when assessing insurability and rate for 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.
In the current Affordable Care Act environment, it may seem as though preexisting conditions are not significant, but they used to be, and could be again if the ACA is repealed. Thus, it is important for Americans to understand that very roughly half of us have a health condition that technically counts as “a preexisting condition.”
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 as though “120 million lives were saved because of the ACA.” It doesn’t work like that. The real “at risk” demographic were those who don’t work for large companies, those who had been sick in the past, and those who didn’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 this high-risk category increases dramatically and starts to resemble the 1 in 2 statistics a lot more accurately. 
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 went into effect because they had been sick in the past, can’t be charged extra or denied coverage today. This may change in the future as a proposed GOP repeal and replace plan may use a “Continuous Coverage Exclusion” For Pre-Existing Conditions.
The ACA isn’t all good, but the preexisting conditions provision protects about half of America.
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.
Author: Thomas DeMichele
Thomas DeMichele is the content creator behind ObamaCareFacts.com, FactMyth.com, CryptocurrencyFacts.com, and other DogMediaSolutions.com and Massive Dog properties. He also contributes to MakerDAO and other cryptocurrency-based projects. Tom's focus in all...