1 | Coverage Denied: How the Current Health Insurance System Leaves MILLIONS Behind | Healthreform.GOV “Pre-Existing Conditions” Affect Millions of Americans A large proportion of Americans have health conditions that insurance companies can qualify as “pre-existing conditions.” A pre-existing condition is a medical condition that existed before someone applies for or enrolls in a new health insurance policy. It can be something as prevalent as heart disease – which affects one in three adults1 – or something as life-changing as cancer, which affects 11 million Americans.2 But a pre-existing condition does not have to be a serious disease like cancer or heart disease. Even relatively minor conditions like hay fever, asthma, or previous sports injuries can trigger high premiums or denials of coverage.3 Source 5 and 6 Unattainable Health Coverage Insurance discrimination based on pre-existing conditions makes adequate health insurance unavailable to millions of Americans. In 45 states across the country, insurance companies can discriminate against people based on their pre-existing conditions when they try to purchase health insurance directly from insurance companies in the individual insurance market.4 Insurers can deny them coverage, charge higher premiums, and/or refuse to cover that particular medical condition. A recent national survey estimated that 12.6 million non- elderly adults5 – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years.6 In another survey, one in 10 people with cancer said they could not obtain health coverage, and six percent said they lost their coverage, because of being diagnosed with the disease.7
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