Pre-Existing Conditions: Another Possible Change in American Healthcare?

The Patient Protection and Affordable Care Act (Otherwise known as Obamacare) is one of the most integral pieces of health policy crafted in recent American history. According to the National Conference of State Legislatures, 32 Million Americans, or about 10 percent of the United States’ population, have received healthcare coverage through a series of consumer and social protections. One of the most famous and recognized provisions, allowed individuals who currently had medical conditions to enroll in a health insurance plan, otherwise known as pre-existing medical conditions. Through the creation of the Open Enrollment Period with the Healthcare Exchange, The Affordable Care Act forced insurance plans to cover these conditions. Currently, Texas vs U.S., a lawsuit by 20 Republican governed states, is making its way through the Judicial system, aiming to remove such protections and threatening the health coverage of millions of Americans.

Pre-existing conditions are described as “A medical illness or injury that you have before you start a new health care plan.” (1) The main reason why health insurance companies dubbed this term was to protect from insurance fraud and to maximize profits. (2) Without these lists of conditions, it is very possible that an individual can go without any health coverage until they are in dire need of healthcare. An example would be an individual who is pregnant only obtaining health insurance before children. However, these lists of conditions often include chronic conditions requiring little medical expenditure, such as anxiety, sleep apnea and even acne. Pre-existing conditions previously applied to both individuals who received healthcare coverage through their employers or through government plans and those who purchased coverage directly from companies. Individuals who had such conditions were either denied health coverage outright, or were placed on waiting lists or charged exorbitant amounts. Employer plans tended to cover pre-existing conditions, but others looked through the health histories before deciding coverage and prices. Some states created “high-risk pools” to cover individuals who had health conditions that needed immediate treatment. (3) These pools were limited, often had waiting lists and still left many to pay for their healthcare out-of-pocket. Due to the ACA, these policies of combing through health histories and denying insurance coverage based on an individual’s health are currently not in effect, yet this safety is currently under attack.

In recent years, The Trump Administration has attempted to repeal the Affordable Care Act multiple times, the most famous of which was the American Health Care Act of 2017 (or the AHCA). After these attempts failed, the administration quietly supported efforts such as Texas vs U.S., which aim to weaken the foundational policies of the ACA through removing protections for pre-existing conditions. Approximately 40 percent of Americans have a pre-existing medical condition, and many would be negatively affected by the lack of these fundamental protections. The majority of which live in lower-income and rural areas of the countries, an demographic that already has trouble accessing healthcare in the first place. It is unclear exactly how the repeal of these protections would affect healthcare coverage, as the definition of a “pre-existing condition” is not a medical or scientific one, but a lack of  healthcare coverage has been shown to have detrimental effects on one’s life. (4) With a Supreme Court currently leaning conservative, these protections may possibly be removed. However, certain Democratic candidates for the presidency, such as Bernie Sanders and Elizabeth Warren, have proposed a Medicare-for-All policy that removes the system of purchasing health insurance in favor of automatic health coverage. Currently, the question of if insurance plans will cover individuals with pre-existing conditions depends on our current and future politicians and the Supreme Court.

Edited by: Dany Matar




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