As Many As 1 in 2 Americans Have a Preexisting Condition fact

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).^[1][2][3]

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 This is what is at stake if the ACA repealed (although one should note many states had state-based rules that protected those with preexisting conditions before the law).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: Before the Affordable Care Act nearly 1 in 5 Americans with preexisting conditions were 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.^[4]

RECENT 2017 DATA: See, Health Insurance Coverage for Americans with Pre-Existing Conditions: The Impact of the Affordable Care Act by HHS and Number of Americans with Pre-Existing Conditions by Congressional District by the Center for American Progress.

What Qualifies as a Preexisting Condition?

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.^[5]

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.”

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 watch this video, you will realize how common it used to be to discriminate against people who were likely to make medical claims because they had already made a claim for a condition that could be viewed as preexisting.

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. ^[6]

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.^[7][8][9]

1. Health Insurance Coverage for Americans with Pre-Existing Conditions: The Impact of the Affordable Care Act. HHS.
2. Number of Americans with Pre-Existing Conditions by Congressional District. Center for American Progress.
3. the 2011 estimate on Preexisting Conditions done by HHS
4. 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
5. At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: 129 Million People Could Be Denied Affordable Coverage Without Health Reform
6. Millions with Preexisting Conditions
7. The “Continuous Coverage Exclusion” For Pre-Existing Conditions
8. The “Continuous Coverage Exclusion” For Pre-Existing Conditions
9. Guaranteed Issue