Pre-existing Conditions and Health Insurance

By on August 10, 2012

One of the more popular provisions of the Patient Protection and Affordable Care Act (to use its full name) is the prohibition of insurance companies denying people coverage because of so-called pre-existing medical conditions in their past. Some forms for new policies will have clauses giving the company the right to abruptly cancel in-force insurance if they discover something pre-existent that the patient has hidden from them.

The reason for this is fairly obvious. Insurance companies want to minimize their risk and profit from payments. The ideal person to insure would be an 18-year of with nothing in his or her family history, whose parents both lived past 100, who just started as a librarian at a desk, who will never smoke or drink or use drugs or engage in risky sexual practices, and never become over-weight. There are very few of these folks in the US.

A person who has had a stroke or a heart-attack or a brush with cancer is high risk for an insurance company. But so is someone who is overweight for height, works constructing high-rise buildings, plays a lot of contact sports or is just ‘older.’ A strong family history of breast cancer, or colon cancer or prostate cancer is viewed as a pre-existing condition, even though the condition is not theirs personally. A previous bladder infection may disqualify a woman in some eyes. Or a previous sports injury or just several visits to the doctor in the past for anything sounding like depression. I once recall a girl who was a taller for her age at 12 than the growth chart showed as ideal being denied insurance. Not sure what the company saw as the increased risk there.

In short, many insurance companies want to deny health insurance to the very people who might actually need it. Insurance is a business just like a company that makes widgets and they want to return a lot of money to their stockholders or owners. These are not public service organizations.

George Halvorson

Enter the government, because it makes sense for this country to have a healthy work force if it wants to compete in the global economy. They understand that some way must be found to bring health insurance to all young and working Americans, regardless of a pre-exiting condition, real or imagined. Hence this new provision in the health care law covering more people once denied care.

I learned a lot about the theories and principles of Health Insurance working on a book with George Halvorson several years ago. The best way to deal with risk is not to fob it off on your neighbor or competitor but to create large pools or cooperatives where the risk is spread around and diluted by the sheer numbers of people covered.

In the end risk can only be pre-supposed. No one can tell who is going to get in a car this morning and be injured in an accident. No one can say who will go to the movies tonight and get shot up by someone who is mentally ill and armed to the teeth. A number of the people injured in the Aurora Colorado incident had no health insurance. We don’t know the reason. Was it a pre-existing condition?

Charitable contributions were made to foot some of their bills. No doubt some of the costs will be passed on later to other insured patients in the form of higher rates. This is not enough. What a terrible tragedy if those victims now had to face financial hardships or personal bankruptcy because of high medical bills?

It is comforting to know health care reform in these areas was not derailed by the Supreme Court  or the machinations of a dysfunctional Congress. We now need to push on and finish the challenges at hand.

Tom Godfrey


About Tom Godfrey

2 comments on “Pre-existing Conditions and Health Insurance

  1. st080903 on said:

    The following is just a recent observation of my routine work in the primary care clinic. NOWADAYS, newly enrolled patients to our insurance have been coming in with “PRE-EXISTING CONDITIONS”, which have been unattended to for years, required ( INSTEAD OF a 20-minute visit ) about an hour for an initial visit and up to 5 referrals to various specialists. YET the true challenge remains as whether this new patient will comply with all our recommended lab tests, imaging studies, pharmacologic among other therapeutic regimens, and specialty consultations.

    HEALTH vs. SICKNESS … often like WEALTH vs. POVERTY: while MOST of us would prefer to be healthy & wealthy, at least PART of the reasons WHY some of us continue to be sick & poor NOT because of certain EXTRINSIC but instead INTRINSIC FACTORS, i.e. CHOICES made by our FREE WILLS.

    • TGodfrey on said:

      You raise a theme that primary care doctors are raising more frequently. I hope my recent post on efficiency gets at your frustrations even further. Thanks for commenting. tom

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