Bar | Pre-Existing Conditions by Education (conditions subject to underwriting) | State Health Access Data Assistance Center

Pre-Existing Conditions

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Conditions subject to underwriting
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Automatically declinable conditions

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Data Type

Percent

Definitions

Prior to the Affordable Care Act (ACA), individual market insurers maintained lists of declinable medical conditions. Individuals with a current or past diagnosis of one or more of these conditions were automatically denied coverage. In addition to automatically declinable conditions, underwriters also examined individual applications and medical records for other conditions that could generate significant claims expenses - these are conditions subject to underwriting.

This measure estimates those with conditions subject to underwriting as the percent of adults who have an automatically declinable condition [those who report ever having one or more of the following chronic conditions: diabetes, cardiovascular disease, heart attack, stroke, chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, cancer, kidney disease, arthritis, rheumatoid arthritis, gout, lupus, fibromyalgia, or depression; or adults who are currently pregnant, obese (BMI greater than or equal to 40), or report excessive alcohol consumption], are overweight (BMI greater than or equal to 25), or have ever been told by a medical professional that they have hypertension, high cholesterol, or asthma for the civilian non-institutionalized population 18 years and over.

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Pre-Existing Conditions

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