The catch: the uninsurables
By National Underwriter
By Allison Bell
About 129 million non-elderly U.S. residents have health conditions that could make it difficult for them to buy health coverage in a state that allows medical underwriting, according to analysts at the office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services (HHS).
The analysts discuss pre-existing condition rates in a commentary supporting the Patient Protection and Affordable Care Act of 2010 (PPACA).
If PPACA takes effect as written and works as drafters expect, it will ban most types of medical underwriting starting in 2014. Carriers would still be able to charge higher rates for older insureds and insureds who smoke, and, in some cases, they might be able to use rate surcharges and discounts as wellness program incentives.
The ASPE analysts came up with two estimates of the size of the potentially uninsurable population.
One includes individuals who have such serious health problems, such as cancer or hemophilia, that they qualify for the new federal Pre-existing Condition Insurance Plan risk pool program.
The analysts also prepared a second estimate that includes people with conditions such as obesity, asthma and hypertension who may be able to get coverage but, in markets where individual insurers apply strict underwriting rules, may face the prospect of dealing with higher rates and pre-existing condition exclusions.
About 50 million U.S. residents, or 19% of non-elderly U.S. residents, have serious enough health problems to be uninsurable according to the PCIP standards, the analysts say.
When conditions such as obesity are included, about 50% could be considered uninsurable, the analysts say.
Today, the analysts say, many of those individuals do have health coverage, either because they are in government-run health plan programs or because they are in employer-sponsored group health plans and face no medical underwriting process.
About 82 million group plan members have pre-existing conditions that could make them uninsurable or difficult to insure if they applied for individual coverage and faced an individual underwriting process, the analysts report.
In the 55-to-64 age group, 48% to 86% of the individuals could be considered uninsurable or difficult to insure, the analysts estimate.
Originally published on LifeHealthPro.com