US health insurers have over
the past three years taken an unusually harsh approach to new
membership applications by individuals with pre-existing
conditions, reveals a new study by the Congressional Committee on
Energy and Commerce (CCEC).
The harsh approach seemingly
pre-empts the Affordable Care Act signed into law on 23 March this
year, which from 1 January 2014 will ban the practice of denying
coverage or rejecting claims based on a person’s health status,
including pre-existing conditions.
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According to the CCEC study,
between 2007 and 2009, the four largest for-profit health insurers,
Aetna, Humana, UnitedHealth Group and WellPoint, refused to issue
health insurance coverage to a total of more than 651,000 people
based on their prior medical history.
On average, between 2007 and
2009, the four companies denied coverage to one out of every seven
applicants based on a pre-existing condition.
The CCEC also found that
between 2007 and 2009, the number of people denied coverage for
pre-existing conditions increased rapidly.
Specifically, insurers denied
coverage to 172,400 people in 2007, 221,400 people in 2008 and
257,100 in 2009, an increase of almost 50% over the three
years.
During the same period,
applications for insurance coverage at the four companies increased
by only 16%.
The CCEC noted that one of
the four companies maintained a list of over 425 medical diagnoses
that triggered a permanent denial of health insurance coverage to
applicants.
These diagnoses include
common conditions such as pregnancy, angina, diabetes and heart
disease.
According to the CCEC, a
recent study found that 57.2m people under the age of 65 suffer
from at least one diagnosed condition that could put them at risk
for denial of coverage, based on pre-existing conditions if they
tried to purchase individual health insurance as a new
subscriber.
Existing members also came
under pressure, with the CCEC noting that between 2007 and 2009,
the four insurers refused to pay a combined total of 212,800 claims
for medical treatment due to pre-existing conditions.
The CCEC highlighted that
each of the four insurers had a business plan that relied on using
pre-existing conditions to limit the amount of money paid for
medical claims.
While most Americans receive
health insurance coverage through plans sponsored by their
employers,ms of people who cannot obtain health insurance through
their employers and do not qualify for government programmes such
as Medicare or Medicaid, can obtain health insurance only through
the individual market.
In 2008, about 15.7m adults
under 65 received their health care coverage through individual
health insurance policies.
Collectively, the four
insurers assessed in the CCEC study covered 2.8m people in the
individual health insurance market in 2009.
As from 2014, health insurers
selling coverage in the individual market will be allowed to set
their rates based only on geography, whether the plan covers an
individual or family, age and tobacco use. Insurance companies will
also no longer be able to use medical histories to calculate
premium rates.
For children under the age of 19, reforms contained in the
Affordable Care Act became effective in September 2010.
