If nothing else, the health care debate has produced some interesting studies. The most recent, released this week, zeroes in on pre-existing conditions. A pre-existing condition is defined as a health condition that exists before a person submits an application for health insurance. In truth, it is one of a list of health problems that require elevated levels of care, either acute or chronic. Insurers are notorious for denying or limiting coverage because of a pre-existing condition -- and, of course, because of the costs associated with the condition.
The U.S. Department of Health and Human Services developed the list of conditions by reviewing information from state-run high-risk pools and major for-profit health insurance companies. The researchers then reviewed health data for Americans under the age of 65. Their conclusions are surprising and have added fuel to the arguments of health care reform opponents.
The study concluded that 50 to 129 million Americans under age 65 -- that is, 19 to 50 percent -- have a pre-existing condition. One in five, or 25 million, of those with a pre-existing condition have no health insurance. About 82 million Americans whose insurance is sponsored by an employer have a pre-existing condition. Such conditions will limit these workers' ability to obtain coverage if they become unemployed, self-employed or employed by a company that does not have an insurance plan.
Insurers generally accept everyone who enrolls through a group insurance policy. Individual policies are harder to obtain, primarily because of the pre-existing condition provision. A person with asthma or diabetes can be denied coverage, can be charged a higher premium or can be offered a policy that excludes costs associated with the condition. The study quotes a national survey that found that 36 percent of applicants looking for individual coverage were met with one of these responses.
The pool of individual policy candidates is growing as more and more people lose their jobs and companies limit coverage to keep their own costs down. Five million Americans lost their employer-sponsored insurance between 2007 and 2009. The number of small businesses offering sponsored health insurance plans dropped 10 percent in that same time period. The increase in the pool of candidates seems not to have affected demand: The number of Americans with individual policies has remained flat.
Critics say the HHS study is exaggerating the situation. According to a representative from America's Health Insurance Plans, most applications are accepted; people are getting coverage. The organization's own 2009 study found that nine in 10 non-elderly Americans are covered through their employers, and nine in 10 who apply for individual policies are accepted.
The implications of the HHS study for any of the health care reform measures is beyond the scope of our blog. What we will be watching closely from our Miami offices is how any legislation affects the way insurance companies treat their policyholders and their providers.
Resource: Fox News "Insurers Dismiss Administration Claims on Pre-Existing Conditions Barrier" 01/18/11