Now that the House has passed a health care overhaul bill that’s moved on to the Senate, preexisting conditions are on everybody’s mind.
The future for those with preexisting conditions looks grim
Before the Affordable Care Act (aka Obamacare) went into effect, insurers were allowed to charge you higher premiums if you had a preexisting condition. That’s if they would even insure you at all with a preexisting condition!
But redlining people based on past medical history was firmly banned under Obamacare.
Now after seven years of being protected from higher premiums, people with preexisting conditions very well could be in for a change under the proposed American Health Care Act (AHCA) of 2017.
As it stands now, the AHCA would potentially allow insurers to once again set premiums based on medical history under two conditions:
- You would only be subject to inflated premiums if you have a preexisting condition and let your coverage run out.
- The state in which you live will have to set up a high-risk pool to provide assistance with those potentially higher premiums.
The AHCA calls for $138 billion in funding through 2026 to help states and insurers keep premiums lower and establish those high-risk pools to help mitigate costs for people with pre-existing conditions.
Basically, here’s how it would work under the proposed plan: states would have to set up a risk program – such as a high-risk pool – that would provide financial assistance to people with preexisting conditions who are being charged higher premiums. If you aren’t enrolled in that risk pool, your options would be pretty limited.
But how much could someone with a preexisting condition potentially pay going forward?
Well, we don’t yet know.
In fact, the estimates are all over the board — from AARP suggesting those in high-risk pools could see annual premiums as high as $25,000 to the more tempered $5,400 annual premium that we know was paid in 2011 by the average 55 -year-old person in Wisconsin’s high-risk pool.
While $5,400 sounds a lot better than $25,000, we should note that there was a six-month waiting period in Wisconsin before coverage kicked. There was also a lifetime benefits cap of $1 million, which CNN Money notes isn’t very much for a truly sick person.
What exactly is defined as a preexisting condition?
Ultimately, it will be up to the insurers to define what counts as a preexisting condition as we move forward.
But there is some precedent here we can rely on for a look-see into the future. The Kaiser Family Foundation notes that the conditions listed below have been used in the past to deny people health coverage or raise premiums.
Once you get out beyond the usual suspects — AIDS, Alzheimer’s/dementia, cancer, congestive heart failure, diabetes, obesity and stroke, among others — it gets a little granular.
- Celiac Disease
- Heart burn
- High cholesterol
- Kidney Stones
- Knee surgery
- Lyme Disease
- Postpartum depression
- Seasonal Affective Disorder
- “Sexual deviation or disorder”