|Healthcare Business News, By Jessica Zigmond –
April 26, 2012: Hypertension, mental health disorders and diabetes are the most commonly found medical conditions among adults that could lead to a health insurer denying coverage, the Government Accountability Office concluded in a new report about pre-existing conditions (PDF).
GAO analysts found that between 36 million and 122 million adults—representing a range between 20% and 66% of the U.S. adult population—reported having medical conditions that could result in health insurance coverage restrictions. The midpoint of that spectrum is estimated to be about 32%.
Hypertension was the leading condition that could result in an insurer denying coverage, and GAO analysts found that about 33.2 million adults between the ages of 19 and 64, or about 18%, reported having hypertension in 2009. Those individuals reported average annual expenditures to treat the condition of about $650, although maximum reported expenditures were calculated to be about $61,540. Cancer had the highest annual treatment expenditures at about $9,000.
Starting in 2014, the Patient Protection and Affordable Care Act won’t allow insurers in the individual market to deny coverage, increase premiums or restrict benefits because of a pre-existing condition.
“The estimated number of adults with pre-existing conditions varies by state, but most individuals, 88% to 89% depending on the list of pre-existing conditions included, live in states that do not report having insurance protections similar to those in PPACA,” the report noted. “Compared to others, adults with pre-existing conditions spend thousands of dollars more annually on healthcare, but pre-existing conditions are common across all family income levels.”
In a letter to the GAO (PDF), Jim Esquea, HHS’ assistant secretary for legislation, said HHS does not have any “substantive or technical comments,” about the report’s findings.