More Than 1 in 4 Non-Elderly Adults Have Pre-existing Conditions

As the Trump administration backs a repeal of the individual mandate, a new study offers a 'conservative estimate' on threats to coverage in the individual market.

More than 52 million Americans under age 65 have a pre-existing medical condition that would likely leave them uninsured in the individual market under state regulations that existed before the Affordable Care Act was enacted.

That's according to a new Kaiser Family Foundation issues brief, which notes that many in this potentially vulnerable group of adults, representing 27% of the total population, now get their coverage through their employers or government programs, and do not have to face medical underwriting on the individual market.

However, KFF says the findings provide a perspective on how many people would be at risk under pre-ACA standards if they were to lose their coverage.

"This is a conservative estimate as these surveys do not include sufficient detail on several conditions that would have been declinable before the ACA (such as HIV/AIDS, or hepatitis C)," the brief said.

"Additionally, millions more have other conditions that could be either declinable by some insurers based on their pre-ACA underwriting guidelines or grounds for higher premiums, exclusions, or limitations under pre-ACA underwriting practices," the brief said.

The study comes amid ongoing efforts by the Trump administration and Congressional Republicans to repeal or hobble the ACA, and give states the opportunity to re-impose coverage denials for pre-existing conditions.

Most recently, the Trump administration's efforts to kneecap the ACA includes efforts to have the individual mandate declared unconstitutional by the U.S. Supreme Court. Critics contend that removing the mandate would destabilize the individual insurance markets and lead to their collapse.    

Among the findings:

• Nearly 30 million non-elderly women and 22.8 million non-elderly men have declinable preexisting conditions. Pregnancy accounts for some of the difference.
    
• The rates of declinable pre-existing conditions vary from state to state, from 41% in Kingsport, Tennessee to 20% in Logan, Utah and Rochester, Minnesota.
   
• Rates are higher in other states, particularly in the South, where in Tennessee (32%), Arkansas (32%), Alabama (33%), Kentucky (33%), Mississippi (34%), and West Virginia (36%), at least one-third of the non-elderly population would have declinable conditions.
   
• The prevalence of pre-existing conditions can vary by 10% or more between cities in the same state. For example, in Kansas 32% of Topeka’s population has a pre-existing condition, as compared to 21% of Manhattan’s population.