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Analysis

Pre-Existing Conditions Rife Across the US

By HealthLeaders Media Staff  
   October 09, 2019

The updated analysis comes as a federal appeals court weighs the future of the Affordable Care Act.

Almost 54 million people – or 27% of all adults under 65 —have pre-existing conditions that would have made them uninsurable in the individual markets that existed in most states before the Affordable Care Act, an updated analysis by Kaiser Family Foundation shows.

The rate of declinable pre-existing conditions among adults varies significantly from state to state, ranging from 37% in West Virginia, to 22% in Colorado, the analysis shows.

Forty-four percent of adults ages 55-64 were more likely to have pre-existing conditions, more than double the rate of adults ages 18-34 (18%). Women (30%) are more likely than men (24%) to have declinable conditions, and 45% of non-elderly families have at least one adult with a pre-existing condition.

The updated analysis comes as the Fifth Circuit Court of Appeals considers Texas v. Azar, a lawsuit seeking to invalidate the Affordable Care Act, including provisions that protect people from coverage denials for pre-existing conditions. 

"While we cannot predict how the court would fashion relief if these ACA provisions were overturned, access to individual market insurance for people with pre-existing conditions could be seriously reduced," the analysis said.

The analysis used 2018 data from two large government surveys to estimate the number of nonelderly adults in each state with a health condition that could lead to a denial of coverage in the individual insurance market, based on pre-ACA field underwriting guides for brokers and agents, KFF said.

The estimates do not include people with other health conditions that would not necessarily cause a denial, but could lead to higher insurance costs based on underwriting, KFF said. 


KEY TAKEAWAYS

The rate of declinable pre-existing conditions among adults varies significantly from state to state, ranging from 37% in West Virginia, to 22% in Colorado.

Forty-four percent of adults ages 55-64 were more likely to have pre-existing conditions, more than double the rate of adults ages 18-34 (18%).

Women (30%) are more likely than men (24%) to have declinable conditions, and 45% of non-elderly families have at least one adult with a pre-existing condition.


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