Between 2010 and 2014, the share of Americans with pre-existing conditions who went without health insurance all year fell from 13.8 percent to 10.7 percent, a drop of by 22 percent, according to an analysis by the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE). This drop means that 3.6 million fewer people with pre-existing conditions were uninsured. In addition, while data for individuals with pre-existing conditions are available only through 2014, the ASPE believes that because the uninsured rate has fallen by an additional 22 percent through mid-2016, those with pre-existing conditions have likely seen similar additional reductions (ASPE Issue Brief, January 5, 2017).
ACA effect. The ASPE attributes the reduction of those with pre-existing conditions being uninsured to section 1201 of the Patient Protection and Affordable Care Ace (ACA) (P.L. 111-148), which added section 2704 to the Public Health Services Act (PHSA) (42 U.S.C. §300gg-3), requiring individual market insurers to offer comprehensive coverage to all enrollees, on common terms, regardless of medical history. This meant that, starting on or after January 1, 2014, health insurance companies could not refuse to cover an individual or charge an individual more just because they have a health problem they had before the date that new health coverage starts.
Findings. The ASPE analysis found that up to 133 million non-elderly Americans may have a pre-existing condition. It determined that the most common pre-existing conditions are high blood pressure (46 million people), behavioral health disorders (45 million people), high cholesterol (44 million people); asthma/chronic lung disease (34 million people), heart conditions (16 million people), diabetes (13 million people), and cancer (11 million people). Other key findings included the following:
- the likelihood of having a pre-existing condition increases with age;
- up to 84 percent of those ages 55 to 64 (31 million people) have at least one pre-existing condition;
- about 23 percent (31 million people) experienced at least one month without insurance coverage in 2014; and
- nearly one-third (44 million people) went uninsured for at least one month during the two-year period beginning in 2013.
Conclusion. With data available only through 2014, the analysis provides only a preliminary picture of how the ACA is helping individuals with pre-existing conditions. Nonetheless, ASPE believes that their analysis confirms that the ACA’s insurance market reforms are providing important protections to Americans whose medical history previously put them at risk of being denied access to affordable health care.
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