49% Of People with Pre-Existing Conditions Denied Health Insurance, Report Says

October 13, 2010

One of the larger elements of the health insurance reform laws that were passed earlier this year was a ban on coverage denials for people with pre-existing health conditions. However, that part of the legislation is not yet in force and, perhaps in anticipation of times to come, the top for-profit health insurers in the country have increased their denials based on medical history by roughly 50% over the last few years.

According to Reuters, a report released on Tuesday by the House Energy and Commerce Committee’s top Democrats, the number of people who have been refused health insurance plans for pre-existing conditions by Aetna, Humana, United Health Group, and WellPoint has risen by 49 percent in the past three years. These denials have affected thousands of individuals trying to buy their own insurance. In 2009, for example, 257,100 people were denied coverage, up from 172,400 in 2007.

Overall, said committee members, insurance companies refused to sell plans to one in every seven applicants, or more than 651,000 people.

While the health care reforms passed last March would make such denials illegal, those protections don’t kick in until 2014. Until then, only children have guaranteed coverage – and, speaking of children – all four of those insurance consider pregnancy to be a pre-existing condition, which triggers automatic denials. As well, most of them won’t cover maternity care under policies issued to women who are not already pregnant, though some do offer additional pregnancy “rider” policies.

The result? According to the report, “…women who are pregnant, expectant fathers, and families attempting to adopt children are generally unable to obtain health insurance in the individual market.” As with other pre-existing conditions, changes to maternity coverage don’t come into force until 2014.

Currently, consumers can apply for coverage through a temporary national program that functions as a stop-gap.

With these results coming out just weeks before the mid-term congressional elections, Democrats are using them to tout the health laws passed last spring. Even so, consumer advocates say there is precious little relief available to those who are not insured through an employer or government program.

Steven Findlay, a senior health policy analyst with consumers Untion explained to the press, “We will continue to see an insurance market that does not allow people to get in. Some companies may try to clean up their act a little bit.”

The America’s Health Insurance Plans, an organization which represents American health insurers and largely fought against the health care reform law passed this year, has said that companies must determine a potential customer’s health beforehand to prevent individuals from seeking coverage only after they get sick. “Health plans recognize that individuals with pre-existing medical conditions have difficulty obtaining coverage,” AHIP spokesman Robert Zirkelbach said.