Generally speaking, a preexisting condition is a health condition that exists prior to enrollment in a health insurance policy.
The Kaiser Family Foundation estimates that at least one-quarter of adults in the United States have preexisting conditions that could impact their health insurance choices.
Protections for preexisting conditions
In the past, insurers could deny coverage for preexisting conditions or charge excessively high premiums for patients with preexisting conditions.
The federal Affordable Care Act (commonly known as “Obamacare”) requires insurers to offer coverage for people with preexisting conditions. The Affordable Care Act also limits how much the cost of insurance can vary, so people with preexisting conditions can buy (relatively) affordable insurance.
If you have a preexisting condition in New Hampshire, insurance companies cannot refuse to cover your condition. You can purchase insurance on New Hampshire's health insurance marketplace or, if you meet income limits, you may enroll in Medicaid.
The debate over preexisting conditions
Polls show that most citizens – and most lawmakers – agree that people with preexisting conditions should have access to health insurance.
The debate then centers on whether insurers should be required to cover preexisting conditions – as is the case under the Affordable Care Act – or if the government should fund some other assistance program for people with preexisting conditions.
When insurers are required to cover preexisting conditions, healthy people see higher insurance premiums to cover the cost of treatments for those conditions.
If the government instead offers some public assistance for people with preexisting conditions, they must raise taxes or cut other government services to pay for it.
Lawsuit threatens preexisting condition coverage
The current requirement to cover preexisting conditions is threatened by a new lawsuit against the Affordable Care Act.
Twenty states are suing the federal government, arguing that when Congress repealed the individual mandate to buy health insurance in 2017, it invalidated the entire Affordable Care Act. If those states win their case, most of the federal protections for people with preexisting conditions would end.
However, Medicaid and Medicare would continue to offer coverage to low income people, senior citizens, and some people with disabilities, regardless of whether they have preexisting conditions.
Change unlikely in US Congress
Republicans in Congress have offered several proposals to repeal and replace the Affordable Care Act. Those “replace” plans include some alternative protections for people with preexisting conditions.
For example, some proposals would still require insurers to cover preexisting conditions, but would allow insurers to charge higher premiums. Other proposals would fund a so-called “high risk pool” to subsidize health care costs for people with preexisting conditions.
However, now that Democrats control the U.S. House of Representatives and Republicans control the U.S. Senate, any health care reform bill faces a huge uphill battle.
Can NH offer protection for preexisting conditions?
If courts strike down the Affordable Care Act, states may step in to cover people with preexisting conditions.
Each state has the right to regulate health insurance sold within its borders, so New Hampshire could require insurers to offer coverage for preexisting conditions.
New Hampshire already has some state laws related to preexisting conditions. For example, if a New Hampshire insurer is looking for preexisting conditions, they can only look at treatment a person received in the last three months. An insurer may also only deny coverage for treatment related to a preexisting condition for the first nine months after enrollment.
However, state regulation does not apply to self-funded health insurance offered by large employers and business associations across state lines. Only the federal government can regulate those plans.
New Hampshire could also re-instate its high risk pool as a way to help people with preexisting conditions. The high risk pool used a tax on insurance companies to subsidize health insurance for people with preexisting conditions.
New Hampshire ended its high risk pool when the Affordable Care Act required private insurers to cover preexisting conditions. The patients in the high risk pool were transitioned to private insurance.
How do you think the state should help people with preexisting conditions? Share your thoughts in the comment below.