GAO re­port: Mil­lions of adults have pre-ex­ist­ing con­di­tions

Modern Healthcare - - LATE NEWS -

Be­tween 36 mil­lion and 122 mil­lion adults—rep­re­sent­ing a range be­tween 20% and 66% of the U.S. adult pop­u­la­tion—re­ported hav­ing med­i­cal con­di­tions that could re­sult in health in­sur­ance cov­er­age re­stric­tions, ac­cord­ing to a re­port by the Gov­ern­ment Ac­count­abil­ity Of­fice. Hy­per­ten­sion, men­tal­health dis­or­ders and di­a­betes are the most com­monly found med­i­cal con­di­tions among adults that could lead to a health in­surer deny­ing cov­er­age, the GAO con­cluded. Hy­per­ten­sion was the lead­ing con­di­tion that could re­sult in an in­surer deny­ing cov­er­age, and GAO an­a­lysts found that about 33.2 mil­lion adults be­tween the ages of 19 and 64, or about 18%, re­ported hav­ing hy­per­ten­sion in 2009. Those in­di­vid­u­als re­ported av­er­age an­nual ex­pen­di­tures to treat the con­di­tion of about $650, although max­i­mum re­ported ex­pen­di­tures were cal­cu­lated to be about $61,540. Can­cer had the high­est an­nual treat­ment ex­pen­di­tures at about $9,000. Start­ing in 2014, the Pa­tient Pro­tec­tion and Af­ford­able Care Act won’t al­low in­sur­ers in the in­di­vid­ual mar­ket to deny cov­er­age, in­crease pre­mi­ums or re­strict ben­e­fits be­cause of a pre-ex­ist­ing con­di­tion. “Com­pared to oth­ers, adults with pre-ex­ist­ing con­di­tions spend thou­sands of dol­lars more an­nu­ally on health­care, but pre-ex­ist­ing con­di­tions are com­mon across all fam­ily in­come lev­els,” the re­port noted.

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