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CCH® BENEFITS — 01/24/11

Repealing Health Reform Law Would Leave One In Two Non-Elderly At Risk

from Spencer’s Benefits Reports: Without the provisions of the Patient Protection and Affordable Care Act (ACA), as many as 129 million non-elderly Americans who have a preexisting health condition would be at risk of losing health insurance or be denied coverage altogether in 2014, according to a new analysis from the Department of Health and Human Services (HHS).

The HHS report, At Risk: Preexisting Conditions Could Affect 1 in 2 Americans, is a response to efforts in the House of Representatives to repeal the ACA. “Repealing the law would once again leave millions of Americans worrying about whether coverage will be there when they need it,” according to the HHS.

“The Affordable Care Act is stopping insurance companies from discriminating against Americans with preexisting conditions and is giving us all more freedom and control over our health care decisions,” said HHS Secretary Kathleen Sebelius. “The new law is already helping to free Americans from the fear that an insurer will drop, limit or cap their coverage when they need it most. And Americans living with preexisting conditions are being freed from discrimination in order to get the health coverage they need.”

The HHS analysis found the following:

• Between 50 and 129 million (19% to 50%) of Americans under age 65 have some type of preexisting condition such as heart disease, high blood pressure, arthritis, asthma, and cancer. The highest rates of those with preexisting conditions, ranging from 21% to 54%, are among those with employer-sponsored insurance. However, 32 to 82 million people with both health problems and job-based coverage would be vulnerable without the ACA, which lifts limits on annual and lifetime benefits.

• Older Americans between the ages of 55 and 64 are at particular risk of preexisting conditions; 48% to 86% of people in that age bracket have a pre-existing condition.

• Of those under age 65 currently in good health, 15% to 30% report that they are in very good or excellent health with no chronic conditions. However, they are likely to develop a preexisting condition over the next eight years.

• Up to one in five Americans under age 65 with a preexisting condition–25 million individuals–is uninsured.

Prior to the ACA, in the vast majority of states, insurance companies in the individual market could deny coverage, charge higher premiums, and/or limit benefits based on preexisting conditions. Surveys have found that, due to preexisting conditions, 36% of Americans who tried to purchase health insurance directly from an insurance company in the individual insurance market encountered challenges purchasing health insurance.

A number of ACA protections already are in place. For example, insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying on their parents’ coverage up to the age of 26 if they lack access to job-based insurance of their own. Insurers cannot deny coverage to children because of a preexisting condition.

Some uninsured Americans with preexisting conditions already have enrolled in the temporary high-risk pool program called the Preexisting Condition Insurance Plan (PCIP), which provides private insurance to those previously excluded from the insurance market because of a preexisting condition. The PCIP program serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a preexisting condition.

In addition to the ban on discrimination against people with preexisting conditions, in 2014, individuals and small businesses will have access to new, high-quality insurance choices through health insurance exchanges.

For more information, visit http://www.HealthCare.gov/center/reports/preexisting.html.

For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.

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