Monday, May 08, 2017

Pre-Existing Conditions

One of the most contentious elements of the ongoing fecal maelstrom over health care is the responsibility (or not) of insurance companies to cover the treatment of pre-existing conditions. How that term is defined, and what sorts of conditions are considered "pre-existing," are at the heart of the debate.

Here is a good basic definition of pre-existing condition, taken from Investopedia: "Any personal illness or health condition that was known and existed prior to the writing and signing of an insurance contract."

Insurance companies write, price, and issue policies depending on their assessment of the relative risk to their bottom line - that is, the likelihood that they will have to pay out benefits to policyholders. It's obvious that, from a purely business perspective, an insurance company doesn't want to issue a policy to an individual if they already know that individual represents a bad risk - will cost the company far more in benefits than the individual has paid in premiums. The assessment of risk is why auto insurance companies charge more to insure a teenage male driver than a middle-aged female, or cancel the policies of persons whose record shows multiple accidents for which they are at fault. It's why property insurers charge more to protect homes built on top of earthquake fault lines or in areas prone to wildfires.

Health insurance is a bit different, though. Obviously, it's cheaper and a much better risk to insure a person who is young and fit and less likely to need medical care than to insure an older person who, in the natural scheme of things, is probably more prone to conditions which will require increasingly expensive treatment. The paradox is that young, fit people who think they'll live forever don't want to waste* money on insurance ... but later on, when they're older and really need it, they'll have accumulated a raft of pre-existing conditions that may price the necessary coverage out of their reach.

What are some of the pre-existing conditions that are sometimes cited by insurance companies as justification for higher rates, or for the denial of coverage altogether? Here are some of the commonly-cited conditions which have resulted in automatic denial of coverage**:

Alcohol or drug abuse with recent treatment;
Cerebral palsy;
Congestive heart failure;
Coronary artery/heart disease, bypass surgery;
Crohn’s disease;
Kidney disease, renal failure;
Mental disorders (including Anxiety, Bipolar Disorder, Depression, Obsessive Compulsive Disorder, Schizophrenia);
Multiple sclerosis;
Muscular dystrophy;
Organ transplant;
Parkinson’s disease;
Pending surgery or hospitalization;
Pneumocystic pneumonia;
Pregnancy or expectant parent (includes men);
Sleep apnea;
Stroke; and,

That's quite a list, and I'm pretty sure that it covers a significant portion of the population. I'm just glad that my arthritis and sleep apnea were diagnosed well after I'd already obtained my insurance, or I'd be up the creek without a medical paddle.

There are a few other conditions I'm surprised aren't on the list. They include:

Life (after all, if you weren't alive, you wouldn't need to worry about health care);

Poverty (which will, in many cases, prevent you from obtaining the routine care that will prevent the development of other pre-existing conditions); and,

Stupidity (which prevents you from recognizing that you are being screwed by the health care insurance system, and allows you to vote for elected officials who do not have your best interests at heart).

Oh, and it should be noted that while mental disorders are considered a pre-existing condition which will preclude the purchase of health insurance, they are not considered serious enough to preclude the purchase of firearms*** (see Stupidity, above).

If you suffer from anything on this list, or any other list maintained by any of the 50 states or any insurance provider, good luck. You're on your own.

Have a good day. More thoughts tomorrow.


* From their perspective.

** From a December 2016 report on the topic from the Kaiser Family Foundation. You can see the list in context and read the full report here.

*** Not completely accurate, but close.


John Hill said...


Elvis Wearing a Bra on His Head said...

Stupidity and unwillingness to accept facts are two major preexisting conditions.

Mike said...

I don't know if universal healthcare will get passed in our lifetime.

Gonzo Dave said...


allenwoodhaven said...