Pre-existing Conditions: What Counts in Health Care Bill?

Pre-existing Conditions: What Counts in Health Care Bill?

50 Health Issues That Count as a Pre-existing Condition

Alicia Adamczyk

May 04, 2017

 

The Republican plan to repeal and replace the Affordable Care Act (ACA), which narrowly passed a vote in the House today, rolls back protections for people with pre-existing conditions, which could increase health care costs for an estimated 130 million Americans.

The American Health Care Act stipulates that states can allow insurers to charge people with pre-existing conditions more for health insurance (which is banned under the ACA) if the states meet certain conditions, such as setting up high-risk insurance pools. Insurers still cannot deny people coverage outright, as was a common practice before the ACA's passage, but they can hike up premiums to an unaffordable amount, effectively pricing people out of the market.

In fact, premiums could reach as high as $25,700 per year for people in high-risk pools, according to a report from AARP. People who receive insurance through their employer would not be affected, unless they lost their job or moved to the individual insurance market for some other reason.

Photo illustration by Sarina for MONEY; Getty Images (5) 

But what counts as a pre-existing condition? While it depends on the insurer—they have the right to choose what counts as "pre-existing"—these ailments and conditions were universally used to deny people coverage, according to the Kaiser Family Foundation, a nonprofit focusing on health care research.

• AIDS/HIV
• Alcohol or drug abuse with recent treatment
• Alzheimer’s/dementia
• Anorexia
• Arthritis
• Bulimia
• Cancer
• Cerebral palsy
• Congestive heart failure
• Coronary artery/heart disease, bypass surgery
• Crohn’s disease
• Diabetes
• Epilepsy
• Hemophilia
• Hepatitis
• Kidney disease, renal failure
• Lupus
• Mental disorders (including Anxiety, Bipolar Disorder, Depression, Obsessive Compulsive Disorder, Schizophrenia)
• Multiple sclerosis
• Muscular dystrophy
• Obesity
• Organ transplant
• Paraplegia
• Paralysis
• Parkinson’s disease
• Pending surgery or hospitalization
• Pneumocystic pneumonia
• Pregnancy or expectant parent (includes men)
• Sleep apnea
• Stroke
• Transsexualism

But Cynthia Cox, Kaiser's associate director, notes that the above list is a conservative sampling of all of the issues and maladies that insurers could count as pre-existing conditions. " There are plenty of other conditions, even acne or high blood pressure, that could have gotten people denied from some insurers but accepted and charged a higher premium by other insurers" says Cox.

Here are some examples of those other conditions that experts have noted could hike premiums:

• Acid Reflux
• Acne
• Asthma
• C-Section
• Celiac Disease
• Heart burn
• High cholesterol
• Hysterectomy
• Kidney Stones
• Knee surgery
• Lyme Disease
• Migraines
• Narcolepsy
• Pacemaker
• Postpartum depression
• Seasonal Affective Disorder
• Seizures
• "Sexual deviation or disorder"
• Ulcers

The left-leaning Center for American Progress notes that high blood pressure, behavioral health disorders, high cholesterol, asthma and chronic lung disease, and osteoarthritis and other joint disorders are the most common types of pre-existing conditions.

Just how expensive are pre-existing conditions? A recent report from the Center for American Progress found that insurers could charge people with metastatic cancer as much as $142,650 more for their coverage, a 3,500% increase.