HHS: Repeal of Reform Threatens Those with Pre-Existing Conditions

Half of "non-elderly" Americans under the age of 65 — 129 million people—might have a pre-existing medical condition such as high blood pressure or arthritis that could deny them healthcare coverage if the Affordable Care Act is repealed, according to a Health and Human Services report issued Tuesday.

"The Affordable Care Act is stopping insurance companies from discriminating against Americans with pre-existing conditions and is giving us all more freedom and control over our healthcare decisions," HHS Secretary Kathleen Sebelius said in a statement accompanying the report.

"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 pre-existing conditions are being freed from discrimination in order to get the health coverage they need," Sebelius said.

The HHS report comes as majority House Republicans in the newly convened 112th Congress launch their attempt to repeal the healthcare reforms enacted last year by Democrats. By midday Tuesday, House GOP leaders had not responded to the report.

The health insurance lobby, however, disputed the findings.

"We have long agreed that the individual insurance market needs to be reformed, but this report significantly exaggerates the number of people whose coverage is impacted by pre-existing conditions," said Robert Zirkelbach, spokesman for America's Health Insurance Plans.

Zirkelbach said the report fails to note that most Americans get their healthcare coverage from their employers. That coverage does not take into account pre-existing conditions. In addition, he said that nine in 10 people who apply for coverage in the individual market are offered a policy, and that "many others" are eligible for public plans such as Medicaid.

The House vote is viewed largely as a symbolic gesture by Republicans, who made repeal of the healthcare reforms a central issue of the November election that won them the House majority. Democrats remain in control of the Senate, however, and have said they will not consider repeal. In addition, President Obama has threatened to veto any repeal bill in the unlikely chance that it reaches his desk.  

The HHS report said that anywhere from 50 million to 129 million (19% to 50%) of Americans under age 65 have some type of pre-existing condition, including heart disease, cancer, asthma, high blood pressure, and arthritis. Americans between ages 55 and 64 are at particular risk, with 48% to 86% of people in that age bracket living with a pre-existing condition. In addition, the report projected that 15% to 30% of people under age 65 in good health today are likely to develop a pre-existing condition over the next eight years. As many as 25 million people under age 65 with a pre-existing condition are  uninsured, HHS said.

Before the Affordable Care Act, Sebelius said that insurance companies in most states could deny individual coverage, charge higher premiums, and/or limit benefits based on pre-existing conditions. Surveys have found that 36% of Americans who tried to purchase health insurance directly from an insurance company in the individual insurance market encountered challenges purchasing health insurance for these reasons.

Although most of the provisions of the Affordable Care Act don't take effect until 2014, several 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, and insurers cannot deny coverage to children because of a pre-existing condition, HHS said. 

Many uninsured Americans with pre-existing conditions have already enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan, which provides private insurance to those locked out of the insurance market because of a pre-existing 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 pre-existing condition, HHS said.