Report: Millions in area at risk of being denied insurance

By Lena H. Sun
Thursday, May 13, 2010

An estimated 2.6 million people in Virginia, Maryland and the District have diagnosed preexisting medical conditions that could put them at risk of being denied insurance coverage if they try to buy it on their own, according to reports released Wednesday.

The figure comprises nearly 1.5 million people in Virginia, slightly more than 1 million in Maryland and about 114,000 in the District, according to Families USA, a liberal group that advocates universal health care. Its analysis is based on federal data about health conditions and demographic data from the U.S. Census Bureau.

Many of the 2.6 million residents are already covered by employer-sponsored health-care plans. But if they are laid off and unable to continue with employer-sponsored or other temporary coverage, they are at risk of either being denied or getting charged higher premiums in the individual market, said Ron Pollack, executive director of Families USA.

Under the Obama administration's health-care legislation, starting in 2014, insurers will be prohibited from turning people away or charging higher premiums because of someone's medical history or health risk.

"Once health reform is fully implemented, these folks will no longer be vulnerable," Pollack said.

The report is part of the advocacy group's effort to highlight specific benefits of the health-care changes in the continuing battle to shape public perception about the overhaul.

"People are confused about what's in the legislation, and many people simply don't understand the specifics," Pollack said.

The analysis is not a complete picture of everyone affected because it does not include every condition that might lead to a denial of coverage.

The actual number is likely higher because analysts used data for only 61 serious medical conditions -- including cancer, diabetes and multiple sclerosis -- that are commonly linked to coverage denials. Not included are common illnesses, such as asthma and hay fever, that can trigger high premiums, denials of coverage or refusal to cover that particular medical condition, said Kim Bailey, a senior health policy analyst at Families USA.

Nationwide, the group estimates that about 57 million people younger than 65 -- about one in five -- have a preexisting condition that could lead to denial in today's individual insurance market.

In Maryland, Virginia and the District, individuals in every age group are affected by preexisting conditions that could lead to a denial of coverage. But those who are older, 55 to 64, are much more likely to have such a condition, according to the reports.

About one in five residents in each of the jurisdictions has a preexisting condition that could lead to denial of coverage, according to the findings. Every income group is affected, but the lowest-income residents are the most likely to have such a condition.

Federal, state and local government officials said they do not have comparable data.

A spokesman for America's Health Insurance Plans, an industry group that represents insurers, said insurers don't have their own data about people with preexisting conditions. "But we have no reason to question this data," spokesman Robert Zirkelbach said.

He said insurers have supported legislative changes "to make preexisting conditions a thing of the past." He said a recent survey by the group found that individual coverage is more accessible than widely believed.

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