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Dispelling the Myths of Health Care Reform: Individual Choice – Pre-Existing Conditions

Myth: Under health care reform, choice will be taken away from the individual and people will be forced into certain plans as decided by the government.

Fact: Heath care reform will open up more options for individuals to purchase the health care they choose by regulating the grounds on which insurance companies can deny coverage(including denial based on pre-existing conditions).

A pre-existing condition is considered to be any medical condition that existed before an individual applies for a new health insurance policy. The condition can be something as serious as heart disease or cancer, or as common as hay fever, asthma, or a sports injury. These conditions can lead to higher premiums or a complete denial of coverage.

In 45 states, it is legal for insurance companies to discriminate against people purchasing health insurance based on their pre-existing conditions. In nine states, being a survivor of domestic violence is considered a pre-existing condition.

Insurers can deny coverage, charge higher premiums, and/or refuse to cover medical conditions of individuals with pre-existing conditions. If a person with a pre-existing condition is able to obtain coverage, insurers are then permitted to exclude whole categories of coverage that relates to the pre-existing condition. For example, someone considered to have a pre-existing condition of hay fever, could have coverage for a respiratory system disease, such as bronchitis or pneumonia, excluded from their coverage. For many individuals, the options available for insurance are very limited or even just partial coverage, and it is still very expensive.

Under health insurance reform, insurance companies will be prohibited from refusing coverage because of someone’s medical history or health risk. Coverage will be more affordable, so people with pre-existing conditions will not have to pay exorbitant costs for partial coverage. People will have more choices when it comes to affordable and complete coverage.


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