Over 22% of non-elderly Americans may be denied coverage due to pre-existing health conditions

Approximately 57.2 million people under the age of 65—more than one in five (22.4 percent) of America's non-elderly population—have a diagnosed pre-existing condition that could lead to a denial of coverage in the individual health insurance market, according to a report released today by the consumer health organization Families USA.

“As more and more people learn about these protections, they will no doubt cherish the enactment of health care reform.”

Once the newly-enacted health reform law is implemented, these people will gain significant protections: The new law prohibits insurance companies from denying health coverage to people due to pre-existing conditions; from charging discriminatory premiums based on health status; and from excluding benefits that would treat their health conditions.

The report shows that, while individuals in all age groups have pre-existing health conditions, this is a problem that grows with age:

• Nearly one in six (15.9 percent of) young adults aged 18 to 24 have a diagnosed pre-existing health condition that could lead to a denial of coverage.
• More than one-third (35.3 percent) of adults aged 45 to 54 have a diagnosed pre-existing condition that could lead to a denial of coverage.
• In the 55 to 64 age group, the portion of adults with diagnosed pre-existing conditions climbs to more than two in five (45.5 percent).
• Although the portion of children under 18 years of age with diagnosed pre-existing conditions is low compared to adult groups, there are nearly 5 million children with such conditions.

"The tens of millions of Americans with diagnosed health conditions, and the many others who at some point may receive such a diagnosis, are the people most in need of health care coverage," said Ron Pollack, Families USA's Executive Director. "Thankfully, the new health reform legislation will protect all these individuals from the most harmful insurance company abuses that deny such critical coverage."

In its analysis, Families USA indicated that the 57.2 million number may understate how many people have pre-existing conditions because it only reflects those with diagnosed pre-existing conditions. Americans who are currently uninsured or underinsured, and who cannot afford care, often do not seek treatment and, as a result, their health condition may not be diagnosed.

The uninsured and those who do not have access to job-based coverage are at greatest risk; however, even those who now have coverage at work could be at risk if they lose or leave their jobs and have to find coverage in the individual market.

Income is no protection against an individual's having a pre-existing condition that could lead to a denial of coverage, and the 57.2 million Americans with diagnosed pre-existing conditions range across all income levels.

• The lowest-income Americans are most likely to have a pre-existing condition. Nearly one-quarter (24.2 percent) of those individuals in families with incomes below 100 percent of the federal poverty level—less than $22,050 for a family of four—are affected.
• Approximately 21.9 percent of individuals in families with incomes between 100 and 199 percent of poverty—between $22,050 and $44,100—are affected.
• While the lowest-income Americans are slightly more likely to be affected by pre-existing conditions, more than two-thirds (69.8 percent) of those with pre-existing conditions that could lead to a denial of coverage are middle class and higher-income Americans. These are individuals in families with incomes above 200 percent of poverty, or more than $44,100 for a family of four in 2010.

Individuals in every racial and ethnic group have diagnosed pre-existing conditions that, absent reform, could lead to a denial of coverage.

• Approximately one-quarter (24.4 percent) of non-Hispanic whites have pre-existing conditions.
• Nearly one-quarter (23.4 percent) of African Americans (non-Hispanic) have such a condition.
• Slightly more than one-quarter (25.9 percent) of American Indians and Alaska Natives are affected.
• More than one in six (16.9 percent) Hispanics are affected. It is important to note, however, that disparities in access to care and in the delivery of care may mean that many individuals have a pre-existing condition that has not been diagnosed. For example, more than a quarter (25.2 percent) of Hispanic adults had no health care visits in 2007, compared to 14.7 percent of non-Hispanic adults.

"As our study shows, more than one-fifth of the non-elderly population will now gain protections that they need to secure affordable health coverage," said Pollack. "As more and more people learn about these protections, they will no doubt cherish the enactment of health care reform."

The data for the report were based on data on health conditions from the federal Medical Expenditures Panel Survey and demographic data from the U.S. Census Bureau's Current Population Survey (CPS). Families USA commissioned The Lewin Group to analyze the data.

A full description of the methodology is in the Technical Appendix of the report, which can be found at:

http://www.familiesusa.org/assets/pdfs/health-reform/pre-existing-conditions.pdf