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What Do They Mean When They Talk About Pre-Existing Health Conditions?

October 23, 2012

Network faithful are advised to spend a few minutes reading a wonderful article from the Kaiser Family Foundation that focuses on how each of the Presidential candidates would approach the issue of pre-existing conditions. People who have a health problem or who are at higher than average risk of needing health care are referred to as having a pre-existing health condition.  Health plans have an interest in controlling access to coverage for people with pre-existing health conditions because, depending on their condition, they are more likely to use covered services than other enrollees in a health plan. While the news is full of talk about people with health concerns like diabetes, coronary artery disease, etc., there is not much talk about children with serious mental health issues who would definitely fit into the class of “pre-existing conditions.” Knowledge is power folks. Read what your candidate is saying about this issue and make an informed choice.

  • (from the article) – People who have a health condition (such as an illness or pregnancy) or who are at higher than average risk of needing health care are referred to as having a pre-existing health condition. The insurance reform provisions of the Affordable Care Act (ACA), when they take effect in 2014, will provide for annual and special enrollment periods when health plans must accept all applicants regardless of their health and prohibit health plans from using health when setting premiums for individuals or small employers.i   Governor Romney has said that he would repeal the ACA and replace it with a plan that provides states with flexibility and resources to address affordability and other issues.  For people with pre-existing health conditions, Governor Romney proposes requiring insurance companies to accept applicants who have maintained continuous coverage and to provide flexibility to states to help the chronically ill, including high-risk pools, reinsurance, and risk adjustment. ii

    Without more details about Governor Romney’s policy proposals, it is difficult to understand the practical differences for people with pre-existing health conditions between his approach and the provisions in the ACA. The issue is further complicated by the fact that the term “pre-existing health condition” is used as shorthand for several different challenges that people with health problems face when they try to get coverage, or when they try to keep or use the health insurance they already have. To provide some context for understanding potential differences between the candidates, we provide a brief description of the key barriers and problems that people with pre-existing health conditions face in the health insurance marketplace now, before the provisions in the ACA take effect.

  • Continue reading here.
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