Remember when....Pre-existing Conditions Mattered.

January 27, 2017

 

A lot has changed in the last month politically, and it has the potential to radically change health care. The 2017 health insurance open enrollment is winding down, and I've been thinking about what health insurance will look like in the future.

 

With that in mind, I've been looking at what applications for health insurance used to look like in the past.  Currently, it's relatively easy during open enrollment - submit your personal information and you are done.  If you want tax credits there are a few more steps to complete.

 

But it hasn't always been this easy.  Thanks to my pack rat ways, I was able to dig up a copy of the 2009 Washington State Health Questionnaire and the Scoring sheet.  It was rather eye opening!

 

Prior to the ACA excluding pre-existing conditions, everyone who applied for coverage in Washington State had to fill out a Health Questionnaire, and if you scored 325 or more, the insurance company could deny you coverage.

 

Here is a copy of the questionnaire.

 

Here is a copy of the scoring.

 

Here are some examples of conditions that would have automatically denied you coverage, and that included a 5 year look back:

  • Autism (severe)

  • Cerebral palsy

  • Crohn's disease

  • Most Cancers

  • Pneumonia (fungal) last 12 months

  • Pulmonary Heart Disease

Now many of us don't have big health issues, but we have a lot of little ones - and it's quite possible that they could add up to a big fat denial.  For instance:

  • Diabetes Type II with other conditions:  206

  • Thyroid conditions:  53

  • Migraine headaches in last 12 months:  110

These three things were enough to get denied coverage.  Once you were denied coverage, you could take the denial letter to the Washington State Health Insurance Pool, and get a plan with the high risk pool.  I was surprised to see that this plan is still available - basically it is available only to those who have been on it since 2013, so I'm hoping there aren't that many people on it.

 

The high risk pool rates were always very high, and they still are.  The current high risk pool rate for a 40 year old in King County on a PPO plan with a $1000 deductible is $1137.  That is more than 2 times the rate for a similar deductible plan on the open market (where pre-existing conditions cannot be excluded). By law, these plans will be discontinued at the end of 2017.  The question is, will we need them to be revived?  I hope not.

 

Pre-existing Conditions, the Individual Mandate, and Open Enrollment

 

The current law states that pre-existing conditions cannot be excluded.  This is paired with the individual mandate requiring everyone to have coverage, along with an open enrollment period limiting when coverage can be purchased.  

 

Why are there limitations as to when you can buy coverage?  It prevents people from buying coverage only when they need it.  If pre-existing conditions were covered, but people did not have to have coverage, then people would buy coverage when they were diagnosed with an illness and drop it when they were healthy.  No system would be able to stand up under that weight.  The healthy and the sick need to share the burden together - and to some extent that's been the problem with our current system.  The healthy would rather pay the penalty for not having coverage.  But what happens when you get sick?

 

Do you have a pre-existing condition?  Would you be able to get coverage under the old rules?

 

 

 

 

 

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