Pre-Existing Condition Prevalence for Individuals and Families

Pre-Existing Condition Prevalence for Individuals and Families

Nearly fifty-four million people, or 27 percent of all U.S. adults under the age of 65, have pre-existing health conditions that would have made them uninsurable in individual insurance markets before the Affordable Care Act's prohibition against denying coverage based on pre-existing conditions went into effect in 2014, an analysis by the Kaiser Family Foundation finds. According to the analysis, Pre-Existing Condition Prevalence for Individuals and Families, medical conditions that insurers could use to deny coverage before passage of the ACA included HIV/AIDS, substance abuse, Alzheimer's or other dementia, inflammatory joint disease, diabetes, epilepsy, heart disease, hemophilia, mental disorders, multiple sclerosis, muscular distrophy, and pregnancy. The study also found that 45 percent of non-elderly families include at least one adult with such a condition, with the share of adults under the age of 65 who could have been denied coverage if not for the ACA ranging from 22 percent in Colorado to more than a third in West Virginia (37 percent), Arkansas (34 percent), Kentucky (34 percent), and Mississippi (34 percent). The Fifth Circuit Court of Appeals' pending decision in Texas v. Azar, which seeks to overturn the ACA in its entirety — including the provisions that prohibit insurers from denying coverage or charging more to people with pre-existing conditions — could, the authors note, fundamentally affect future access to health care for nearly half of non-elderly families.

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November 12, 2019