Dr. Molly Cooke, San Francisco, CA: Our patient was self-employed and uninsurable due to pre-existing hypertension (high blood pressure) and recent onset atrial fibrillation (irregular heartbeat). His lack of insurance made it difficult to do the simplest things like treat his hypertension and perform a basic evaluation addressing possible causes his condition.
Jessica Layton, Illinois: I have been uninsured for 15 years due in part to pre-existing conditions. Jobs that I have held in the restaurant business for the most part do not offer insurance. I hope and pray every day that I do not lose everything I have worked my whole life for due to illness.
Iris Lochner, Edmund, OK: Ten years ago I experienced a cardiac episode. I did not have a heart attack; however, hospital records established my preexisting condition. After being caught up in my company's downsizing, I found myself without health insurance for the first time in my life. I tried to get coverage time and time again, but because of my preexisting condition, I was denied coverage at any cost. I went without any coverage for almost five years. Lucky for me, I stayed well and got by without it. Today the Affordable Care Act would prevent the insurance companies from denying coverage because of past health problems. I was truly one of the "lucky ones"! Any medical problems during that time would have meant financial disaster for me.
Laurencena Jonna, Baltimore, MD: I lost my COBRA in late 2003 and could not obtain health insurance due to several pre-existing conditions. Because of this, I lost my kidney function and was diagnosed with End Stage Renal Disease in 2007. I started dialysis shortly after I turned 48 and Medicare's ESRD program made sure I could afford the over three years in all that I spent on dialysis. I received a gift of life kidney transplant in February, 2008, which was largely covered by Medicare. I am 52 and will probably be taken off Medicare in two years, and because of the Affordable Care Act, I know I will be allowed to buy health insurance to keep my precious kidney from rejecting.
Terrence Sonuga, Florida: When I first moved to Florida, I was 60 yrs old but could not get any health insurance because I was (and still am) a cancer survivor. I had to use drop in clinics and emergency rooms. The smartest thing I ever did was turn 65 so I could get Medicare. I don’t want others in need of care to be without medical help because of pre-existing conditions.
As many as 112 million adults have a pre-existing condition. From newborns with birth defects, kids with asthma, to cancer survivors, to diabetics, even headaches and pregnancy, patients who need regular stable health care the most have been denied the coverage they need. Those who currently have insurance are at risk of losing coverage due to a job change, an employer’s insurance provider change, or getting too expensive for insurance companies to cover.
This needs to end—and it will thanks to the Affordable Care Act.
- Ending discrimination based on pre-existing conditions for children: As of September 2010, insurance companies are no longer allowed to deny coverage to children under the age of 19 due to a pre-existing condition. This means a baby born with a heart condition can receive immediate care at birth without his/her parents worrying about being denied coverage.
- Ending discrimination based on pre-existing conditions for adults: The wait for adults with pre-existing conditions is a bit longer. Starting January 1st, 2014 insurance companies can no longer deny new policies or policy renewals for anyone—regardless of age—due to a pre-existing condition. Insurance companies also can’t charge higher rates due to health status or gender in the individual and small group market.
- Get coverage now: Until the Affordable Care Act is fully implemented, adults over 18 who have been denied health insurance coverage due to a pre-existing condition and have been without health insurance for at least six months you can qualify for the Pre-Existing Condition Insurance Plan (PCIP). The cost varies between states and you can find out more here. As of August 31, 2012, 86,072 people have already enrolled in PCIP.
- Ending the practices of rescinding coverage and spending limits: Before the ACA, insurance companies could go back through your records and after finding a technical error or mistake, they could deny payments for services. Insurance companies could also set limits on how much they would spend for essential benefits—like hospital stays—each year and over your lifetime. These practices have been ended on new policies started after September 2010 and will be gradually faded out by January 2014.
The patients who need to be able to depend on reliable health insurance were at risk for losing that coverage—but not anymore. The Affordable Care Act will remove one of the biggest obstacles up to 1-in-5 nonelderly Americans face when trying to obtain and keep high-quality affordable health care.
Because when we need it the most, the health care system shouldn’t fail us.
*These and all the stories we share are stories collected by doctors and medical students from people in their communities over the past year during their efforts to educate people about the Affordable Care Act.
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