An estimated 52 million adults under the age of 65 are currently living with pre-existing health conditions. And, as the American people await the fate of their new healthcare system, the possibility of not having these not covered by the new insurance plan is sending many into a frenzy. But what exactly is considered to be a pre-existing condition? And how will the plan address these?
What exactly is a pre-existing condition?
A pre-existing condition is defined as any sort of health problem that a person has before the date that their new health coverage starts. Under the current law, health insurance providers cannot refuse to cover a patient or charge them more for a monthly premiums as a result of having a pre-existing condition. So, for instance, if you were diagnosed with diabetes in 2016 and went to apply for coverage in 2017, you were not denied coverage or charged any additional fee for your plan. But, if the new GOP healthcare bill proposal passes, there are concerns that this could all change.
What health conditions are labeled as pre-existing?
While the meaning behind the term “pre-existing condition” is vague and often up to the discretion of an individual healthcare company, here is the list of what most insurance providers have considered to fall into the category in the past. These are also the ailments that benefit holders may have issues with having covered under the GOP’s new plan:
- AIDS or ARC
- Alzheimer’s Disease
- Amyotrophic Lateral Sclerosis
- Anemia (Aplastic, Cooley’s, Hemolytic, Mediterranean or Sickle Cell)
- Aortic or Mitral Valve Stenosis
- Bipolar disease
- Cerebral Palsy (infantile)
- Chronic Obstructive Pulmonary Disease
- Cirrhosis of the Liver
- Coagulation Defects
- Congestive Heart Failure
- Cystic Fibrosis
- Demyelinating Disease
- Esophageal Varicosities
- Friedreich’s Ataxia
- Hepatitis (Type B, C or Chronic)
- Menstrual irregularities
- Multiple Sclerosis
- Muscular Dystrophy
- Myasthenia Gravis
- Organ transplants
- Parkinson’s Disease
- Polycythemia Vera
- Psoriatic Arthritis
- Pulmonary Fibrosis
- Renal Failure
- Sex reassignment
- Sjogren’s Syndrome
- Sleep apnea
If the new plan passes, will pre-existing conditions be covered?
In an interview with CBS News, President Trump assured the public that there are specific clauses in the new bill that protect people with pre-existing conditions. And in the language on the current iteration of the bill, Republication Congressman of New Jersey, Tom MacArthur, wrote that “nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.” So the GOP maintains that these ailments will be covered and that people will not be charged additional fees for their monthly premiums as a result of having been diagnosed with a specific health condition.
But there are loopholes, and that is where the concerns are stemming from. The bill would give states the authority to allow insurers a number of exemptions from the federal law and to potentially waive the protections that it afford the public. For instance, a state can give insurance companies the option of charging patients more for insurance if their coverage lapses for more than 63 days.
“This would guarantee access to insurance for people with pre-existing conditions in theory, but not really in practice — because they could be charged astronomically high premiums,” says Senior Vice President of the Kaiser Family Foundation, Larry Levitt.
Baltimore City Health Commissioner, Dr. Leana Wen, adds that this could mean that patients who need treatment for an array of conditions may not be able to afford health insurance. “States could allow insurers to set much higher rates for patients who have a pre-existing condition. That’s terrifying, because patients could in essence be priced out of coverage,” she explains.
Prior to Obamacare, health insurance companies often refused to cover patients for pre-existing conditions like cancer, mental disorders, and heart disease. The argument was that this was done in order to prevent patients from waiting to sign up for insurance after they were already sick. But organizations like the American Medical Association to the Juvenile Diabetes Research Foundation argue that this allowed health insurers the ability to make up their own definitions of what a pre-existing condition was and ultimately control what to cover and what not to.
The American Academy of Pediatrics recently spoke out about the passage of the American Health Care Act. The organization warns that the bill allows insurers to return to the practice of setting annual and lifetime limits on coverage – “meaning that a premature baby on private insurance could exceed her lifetime limit on coverage before she even leaves the hospital. In addition, the bill allows insurance companies to refuse to cover those with pre-existing conditions, or charge them more for coverage, meaning that conditions ranging from asthma to pregnancy to cystic fibrosis could completely devastate a family financially and leave those who need care unable to access it.”
Possible options for treatment affordability
MacArthur’s amendment to the proposed bill would give states the ability to allow insurers to price plans based on health status for those without continuous coverage. Thus, they could charge customers more than the 30% surcharge that was suggested in the initial bill in the event that their insurance lapsed beyond a period of 63 days. So if the new bills passes, Americans with pre-existing conditions that sign up for a healthcare plan can avoid paying higher monthly fees by maintaining continuous insurance.
If you can’t afford monthly health insurance and have a pre-existing condition, however, there are still ways in which you can go about getting the medical assistance that you need:
Seek treatment at a community health clinic: HealthCare.gov suggests contacting your local community health center, which offers a variety of lower cost treatments such as prenatal care, baby shots, general primary care, and referrals to specialized care such as assistance with mental health disorders, substance abuse, and HIV/AIDs.
Find a doctor that will give you a cash discount: Some medical professionals will give you a cash discount. For instance, if you don’t have dental insurance, you may be able to find a dentist that will give you a teeth cleaning at a discounted flat fee if you pay up front and out of pocket.
Find the cheapest rates on drugs: Use an online resource to help you to find the lowest rates on prescription drugs.
Do your research: Reach out to the Department of Health and Human Services in your area and ask them for a referral, search online for “low-income health care” in your area, or contact a nearby nonprofit and ask to speak with their patient services representative.