Pending appellate court decision could leave millions uninsured.
In 2018, 53.8 million non-elderly adults (27 percent of American adults) have a pre-existing health condition that would have been the basis for denied health insurance coverage in the non-group marketplace or higher charged premiums before the Affordable Care Act (ACA) took effect in 2014. According to a report by the Kaiser Family Foundation, a further estimated 45 percent of nonelderly families have at least one nonelderly adult member with pre-existing health condition. The report noted that pre-existing conditions range from 22 percent of non-elderly adults in Colorado to a high of 37 percent in West Virginia.
Using 2018 data from two large government surveys, the KFF researchers estimated the total number of nonelderly adults in each state with a health condition that could lead to a denial of coverage in the individual insurance market, based on pre-ACA field underwriting guides previously used for insurers. The revised estimates did not include people with other health conditions that would not necessarily cause a denial, but could lead to higher insurance costs based on underwriting. As such, the researchers noted that a pending decision by the Fifth Circuit Court of Appeals (Texas v. Azar), could see a return to insurers using people’s current health status to determine their eligibility and premiums for health insurance.
Although most people with pre-existing health conditions are covered currently by employer-based coverage or public programs, such as Medicaid, the non-group market is where people may need to look for health care coverage as they lose eligibility for work-based or public coverage if they transition between jobs, lose a job, divorce, age-off a parent’s policy, or retire before age 65.
The researchers noted that the economic costs of a having a member of the family denied coverage would be borne by the entire family. A larger share of non-elderly adult women (30 percent) than men (24 percent) have declinable pre-existing conditions in 2018, with the difference largely based on pregnant women, unchanged from 2015.
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