An Estimated 52 Million Adults Have Pre-Existing Conditions That Would Make Them Uninsurable Pre-Obamacare

A new Kaiser Family Foundation analysis finds that 52 million adults under 65 – or 27 percent of that population — have pre-existing health conditions that would likely make them uninsurable if they applied for health coverage under medical underwriting practices that existed in most states before insurance regulation changes made by the Affordable Care Act.

In eleven states, at least three in ten non-elderly adults would have a declinable condition, according to the analysis: West Virginia (36%), Mississippi (34%), Kentucky (33%), Alabama (33%), Arkansas (32%), Tennessee (32%), Oklahoma (31%), Louisiana (30%), Missouri (30%), Indiana (30%) and Kansas (30%).

States with the most people estimated to have the conditions include: California (5,865,000), Texas (4,536,000), and Florida (3,116,000).

Using data from two large government surveys, the analysis estimates the total 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. The results are conservative because the data don’t include some declinable conditions. The estimates also don’t include the number of people with other health conditions that wouldn’t necessarily cause a denial, but could lead to higher insurance costs based on underwriting.

While most people with pre-existing health conditions have coverage through an employer or public program, such as Medicaid, they may intermittently seek insurance in the individual market during times when they’re ineligible for other coverage, such as following a job loss or divorce.  People who are self-employed, early retirees, or lower-wage workers in jobs that don’t provide health benefits often are covered by individual plans for longer periods.

Before ACA protections took effect in 2014, private insurers in the individual health insurance market could use applicants’ health status, health history and other risk factors to determine whether and under what terms to issue coverage. Some examples of conditions which could have led to automatic denial of coverage include cancer, diabetes, epilepsy, heart disease, and pregnancy.

In the post-election health policy debate, both political parties have expressed a desire to continue protecting people with pre-existing conditions.

The new analysis, Pre-Existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA, offers a detailed look at medical underwriting practices common in the individual market before the health law’s prohibitions.