Patient Care Access News

Patient Care Access Key as Patients Report Pre-Existing Conditions

Twenty-seven percent of patients have a pre-existing condition, which would impact patient care access under different care models.

pre-existing conditions

Source: Thinkstock

By Sara Heath

- More than one in four Americans have a pre-existing condition that would impact patient access to health payer coverage, according to a recent Gallup poll. These results shed more light on the national debate about pre-existing conditions and patient care access.

It is often difficult to measure how many patients have a pre-existing condition because of varying definitions, Gallup noted. Different health plans may categorize different conditions has pre-existing conditions.

According to, a pre-existing condition is “A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts.”

Twenty-seven percent of the survey respondents said they have a pre-existing condition, Gallup reported. The survey did not ask respondents to specify which pre-existing condition they have.

Of the 27 percent of respondents with a pre-existing condition, 16 percent are the only ones in their households with a condition. Eleven percent said they and another family member both have a pre-existing condition.

READ MORE: Health Payer Preventive Care, ED Denials Hamper Patient Care Access

Seventeen percent of respondents said one of their family members has a pre-existing condition but that they do not.

This means that 44 percent of households could be impacted by changes to the pre-existing conditions policies in the Affordable Care Act (ACA). Currently, ACA policy states that no health payer can deny coverage to a patient with a pre-existing condition or charge that patient more for coverage.

However, within the past 18 months, there have been mounting efforts to repeal provisions about pre-existing conditions from the ACA, giving payers the ability to deny patients coverage or charge them more because of their pre-existing conditions.

Notably, the American Health Care Act (AHCA), which circulated Capitol Hill during the spring and summer months of 2017, would have repealed protections for pre-existing conditions.

This current data obtained by Gallup shows that 44 percent of households would have been impacted by such a move, limiting their ability to obtain health payer coverage.

READ MORE: How Payers Use Data Analytics for Personalized Member Experience

There are some differences in who suffers from pre-existing conditions, the report continued. For example, only 16 percent of patients between age 18 and 29 have a pre-existing condition. When looking at patients ages 30 to 49, that number climbs to 22 percent.

Those who are near retirement age (between age 50 and 64) have higher likelihood for a pre-existing condition. Thirty-four percent of these patients reported a pre-existing condition. Thirty-eight percent of patients over 65 who are most likely to receive Medicare coverage, have a pre-existing condition.

There were also income disparities, the report added. Only 23 percent of the highest income earners reported a pre-existing condition. Conversely, 34 percent of patients making less than $30,000 annually said they had a pre-existing condition.

These patients are in an especially vulnerable position because they do not have the financial means to pay more for their insurance or may not benefit from private insurance coverage.

Additionally, there are racial disparities. Thirty percent of white patients said they have a pre-existing condition, compared to just 20 percent of non-white patients. This trend may also be due to age, as the median age for white Americans is higher than for non-white Americans.

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As noted above, there are considerable care access implications for patients with pre-existing conditions, the Gallup Poll authors said.

“US healthcare laws that govern insurance coverage for those with pre-existing conditions are not a trivial matter,” the survey authors wrote. “Close to half of Americans could be directly affected by those laws, as they or a household family member have a pre-existing condition.”

Patient access to health insurance coverage is tied to better care and health overall, separate reports have found. An April 2018 report from America’s Health Insurance Plans (AHIP) revealed that patients who have access to Medicaid or CHIP tend to have better care access than those without insurance coverage at all.

Adult Medicaid beneficiaries were five times more likely to have a regular source of healthcare compared to uninsured patients. They were four times more likely to access preventive care.

CHIP beneficiaries were four times more likely to have a regular source of healthcare compared to children without insurance coverage. They were between two and three times more likely to access preventive services.

These results suggest a need for more insurance coverage for patients across the country.

“This new evidence reinforces what insurance providers see every day – Medicaid works for patients and taxpayers,” said AHIP president of Medicaid Policy and Advocacy Rhys Jones. “Medicaid is an important part of America’s safety net and optimizes the use of every dollar invested into the program to ensure those who need help the most get the care they need.”


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