pre-existing conditionsWith the passage of a new healthcare bill in the House of Representatives (it’s still not a law) and a heartfelt monologue by Jimmy Kimmel, there’s been a great deal of talk about pre-existing conditions. Unfortunately, in the discussion, many have lost sight of what exactly that means. Let’s review.

 

What are pre-existing conditions?

With the advent of the Affordable Care Act (Obamacare), insurance companies could not deny coverage for pre-existing conditions. For example, if you had cancer or cystic fibrosis and lost your insurance, the next insurance company might not cover you. Health insurance companies want your premiums but would rather not pay out a benefit. So if you have a pre-existing condition, they would prefer not accept you as a customer because of the risk of a high payout.

 

The Affordable Care Act stopped that from happening. While it didn’t get rid of pre-existing conditions, the Act simply made it a requirement that insurance companies cover anyone with a pre-existing condition. Those patients unfortunately cost more. So rather than charging only the patient astronomical insurance premiums, that cost is spread out to the rest of us.

 

Everyone is welcome to their opinion in regards to whether that is fair or not. That’s not the purpose of this post. The point is to separate fact from fiction regarding pre-existing conditions. In recent discussions, the suggestion is that a child born with a birth defect is now labeled as having a pre-existing condition and can’t get coverage. That led to the suggestion that a child with a pre-existing condition would not get treatment in the hospital at the time of their birth because they couldn’t get insurance.

 

Even kids with pre-existing conditions get coverage

If you think I’m misreading the conversation, I beg to differ. Proponents of Obamacare claim that until the Act’s passage, newborn babies would not get treatment because of their pre-existing condition. So does that mean before Obamacare, a hospital could discharge an ill newborn baby because they didn’t have insurance?! Of course not.

 

Even before Obamacare, there was Medicaid, a state insurance plan. Medicaid has a unique characteristic that differs from all other insurance plans. It covers illness retroactively. That means you can get sick and even if you don’t have insurance and qualify, the hospital will assist you in getting coverage. In other words, Medicaid will agree to pick up the tab even if you got sick before you had insurance! No other insurance does that.

 

And that’s why kids born with congenital abnormalities, even if they have a pre-existing condition, can still get insurance. With or without Obamacare.

 

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.