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Thursday, May 27, 2010 10:00 pm

Eliminating the ‘pre-existing’ problem

Study shows many Illinoisans could have lost health insurance coverage

Without federal health care reform, almost 2.5 million Illinoisans would be at risk of losing their health insurance, a new report says. The report, released by the Campaign for Better Health Care, says 23 percent of Illinois residents have a pre-existing condition that could lead to a denial of coverage in the individual insurance market.

New federal health reform, signed into law March 23, is designed to protect those with pre-existing conditions, says Jim Duffett, executive director of the Campaign for Better Health Care.

Pre-existing conditions are physical or mental health conditions that a person has before joining a health plan. Under the former health care legislation, insurance providers can apply this to any condition for which a person has received medical advice, diagnoses or treatment or for which medical care was recommended, within the six months prior to joining their insurance plan.

Anything from acne to cancer could be considered a pre-existing condition, Duffett says.

The new law prohibits insurance companies from denying people with pre-existing conditions health coverage, charging inflated premiums based on health status and excluding benefits that would treat their health conditions, the Campaign says.

The 2.5 million consists of residents under age 65, the report says. Information was gathered by Families USA, a national nonprofit health care advocacy group.

“As our study shows, nearly one-quarter of the non-elderly population of Illinois will now gain protections that they need to secure affordable health coverage,” says Ron Pollack, executive director of Families.

However, the Campaign for Better Health Care wants to ensure that the national reforms remain in Illinois, even in the unlikely event that the federal legislation is overturned. State legislation means Illinois residents with pre-existing conditions retain the coverage established under the new federal law, even if it is modified later.

“At the core, the new federal health reform law is about providing fairness, and how the states implement federal reforms is what will ensure it,” Duffett says.

Currently, those with pre-existing conditions often end up in the “high-risk pool,” Duffett says, which is a way for people to get health care when companies consider them a liability. Pending state legislation would allow Illinois to form an expanded high-risk pool, which would provide coverage for uninsured people with pre-existing conditions, using approximately $200 million in federal funds.

Duffett’s goal is to make the state’s high-risk pool the same as the national version.

“The high-risk pool will provide affordable coverage for uninsured persons with pre-existing conditions and means fewer Illinoisans will be denied coverage because they had the misfortune to get sick in the past,” Duffett says. “It will make health care coverage more secure by ensuring that working families cannot be denied coverage due to a pre-existing condition, or lose their coverage or be forced into bankruptcy when someone gets sick.”

According to the report, 16.7 percent of young adults aged 18-24, almost 36 percent of adults aged 45 to 54, and almost half – 46.7 percent – of adults aged 55 to 64, as well as 226.900 children under 18 years old have a diagnosed pre-existing condition that could lead to a denial of coverage.

Pre-existing conditions affect people of all ages, races and levels of income, the report says. Which is why Duffett believes protecting their rights is so important.

“You don’t have to worry about losing your job or getting sick,” he says. “It’s going to be an ending of being denied health insurance for pre-existing conditions.”

Contact Diane Ivey at divey@illinoistimes.com.


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