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What are Pre-existing Conditions?
According to healthcare.gov, pre-existing conditions are health problems (like asthma, diabetes, or cancer) that you had before the date that new health coverage starts. According to new estimates from the Center for American Progress, 135 million people under age 65, or about half of non-elderly people, have a preexisting condition that an insurer could use to discriminate against them if they ever sought coverage through the individual market in the absence of ACA protections. |
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This provision of the ACA that protects those with pre-existing conditions enjoys solid public support with 75 percent of people agreeing that it’s important to keep the requirement for insurers to provide coverage for people with pre-existing conditions. Despite that widespread, bi-partisan support, 18 Republican state attorneys general and the Trump administration filed a lawsuit asking the courts to invalidate the entire law. The Trump administration even specifically asked the court to remove the provision that requires insurers to cover those with pre-existing conditions. The case is now at the Supreme Court. If the court rules in favor of the Trump administration and the Republican attorneys general, about 624,000 Pennsylvanians who get coverage in the individual market would either face unaffordable premiums or lose coverage altogether. Another 6.3 million people covered by employer plans would also lose protection.
Pre-existing Condition List (Source: Kaiser Family Foundation) Note: Many additional, less-common disorders also appearing on most of the pre-existing conditions lists were omitted from this table:
Pre-existing Condition List (Source: Kaiser Family Foundation) Note: Many additional, less-common disorders also appearing on most of the pre-existing conditions lists were omitted from this table:
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AIDS/HIV
Alcohol abuse/ Drug abuse with recent treatment Alzheimer’s/dementia Arthritis (rheumatoid), fibromyalgia, other inflammatory joint disease Cancer within some period of time (e.g. 10 years, often other than basal skin cancer) Cerebral palsy Congestive heart failure Coronary artery/heart disease, bypass surgery Crohn’s disease/ ulcerative colitis Chronic obstructive pulmonary disease (COPD)/emphysema Diabetes mellitus Epilepsy Hemophilia Hepatitis (Hep C) Kidney disease, renal failure |
Lupus
Mental disorders (severe, e.g. bipolar, eating disorder) Multiple sclerosis Muscular dystrophy Obesity, severe Organ transplant Paraplegia Paralysis Parkinson’s disease Pending surgery or hospitalization Pneumocystic pneumonia Pregnancy or expectant parent Sleep apnea Stroke Gender Dysphoria |
Fact Check On Pre Existing Conditions
- Approximately 27% of non-elderly adults had a pre-existing health condition in 2018
- In 2018, 45% of non-elderly families included a non-elderly adult with a pre-existing condition
- A larger share of non-elderly adult women (30%) than men (24%) had pre-existing conditions in 201
- 23.7 million men have a pre-existing condition that would have left them uninsurable in the individual market pre-ACA, compared to 30.1 million women (pregnancy explains part (about 2 million women) but not all of this difference)
- The prevalence of pre-existing conditions also increases with age among non-elderly adults: ranging from 18% of those in the 18-34 age group to 44% for those in the 55-64 age group