• Facebook


Pre-existing conditions are back in the headlines, especially as the Supreme Court hears a case that could impact the Affordable Care Act (ACA). The ACA offers important protections for Americans living with pre-existing conditions. In light of this, it’s important to remember what pre-existing conditions are, including how the Affordable Care Act (a.k.a. the ACA, or “Obamacare”) changed how insurance companies treat them.

What exactly is a pre-existing condition?

A pre-existing condition is any health condition you have before your health insurance coverage starts. Some people are born with these conditions. Other people develop them over time.

What is the position of Minnesota’s nonprofit health plans on pre-existing conditions?

Minnesota’s nonprofit health plans favor upholding the Affordable Care Act because we believe that all Minnesotans should be covered, including the 2.3 million in Minnesota with pre-existing conditions. It is also important to remember that some protections for those with underlying health conditions are written into Minnesota state law, particularly for those who have maintained continuous coverage. Minnesota’s nonprofit health plans will always work to get Minnesotans the affordable, equitable and quality-based care they deserve.

What are some health conditions commonly seen as pre-existing?

The 10 most common pre-existing conditions are acne, anxiety, diabetes, asthma, sleep apnea, depression, COPD, extreme obesity, atherosclerosis and cancer. But many others exist, including pregnancy, heart conditions of various types, strokes, care related to transplanted organs and Alzheimer’s.

How many people have pre-existing health conditions?

According to the U.S. Department of Health and Human Services, half of all Americans live with something that would have been classified as a pre-existing condition before the ACA. Kaiser Family Foundation found that more than 54 million non-elderly Americans have at least one health condition that could have caused them to be denied individual insurance coverage before the ACA.

How were pre-existing conditions treated before the ACA?

Before the ACA took effect in 2010, health insurance plans used an underwriting process for individual market plans. In other words, if you bought health insurance on your own instead of getting it from the government or an employer, you had to submit detailed medical records. Insurers would use these records to determine your premiums and other out-of-pocket costs. Depending on the severity of your pre-existing conditions, you could face higher premiums or be given a rider saying that care related to those specific conditions would not be covered or be denied coverage.

If you were denied coverage, Minnesota (and most other states) placed you in a high-risk insurance pool for people with pre-existing conditions that provided limited and often expensive coverage. In fact, it’s estimated that roughly 1 out of 5 Minnesotans currently enrolled in today’s individual insurance market used to be enrolled in the state’s high-risk pool.

What protections did the ACA give people with pre-existing conditions?

Today, pre-existing conditions can’t keep you from getting insurance, and they must be covered under your insurance plan. Under the ACA, health plans are required to provide coverage to everyone who enrolls during the open enrollment period, and they can no longer take your health into consideration when pricing your plan. Instead, they must use “adjusted community ratings” to pay for out-of-pocket expenses so you don’t have to face an endless bill for treating a chronic condition.

How will health plans continue to support those with pre-existing conditions?

Only time will tell what the outcome of the ACA case will actually be, but regardless of what happens, the Council is supportive of the many provisions that support coverage for Minnesotans and bringing forth solutions that improve health care for everyone throughout the state.