Pre-Existing Conditions
Measure Overview
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.
State Health Compare provides a state-level look at the percent of the adult population who have a condition that could result in them being denied health insurance coverage if protections under the ACA were overturned. This is separated into automatically declinable conditions and conditions that are subject to underwriting. Automatically declinable conditions are: diabetes, cardiovascular disease, heart attack, stroke, chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, cancer, kidney disease, arthritis, rheumatoid arthritis, gout, lupus, fibromyalgia, depression, current pregnancy, obesity (BMI greater than or equal to 40), or excessive alcohol consumption. Conditions subject to underwriting are: automatically declinable conditions, being overweight (BMI greater than or equal to 25), asthma, hypertension, and high cholesterol.
State Health Compare provides a state-level look at the percent of the adult population who have a condition that could result in them being denied health insurance coverage if protections under the ACA were overturned. This is separated into automatically declinable conditions and conditions that are subject to underwriting. Automatically declinable conditions are: diabetes, cardiovascular disease, heart attack, stroke, chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, cancer, kidney disease, arthritis, rheumatoid arthritis, gout, lupus, fibromyalgia, depression, current pregnancy, obesity (BMI greater than or equal to 40), or excessive alcohol consumption. Conditions subject to underwriting are: automatically declinable conditions, being overweight (BMI greater than or equal to 25), asthma, hypertension, and high cholesterol.