Before and After the Affordable Care Act/Obamacare, Part 1

After considerable discussion and debate, the Affordable Care Act, aka Obamacare, was passed/enforced on March 23, 2010. One of the key factors was protection from insurance company exclusions and waiting periods for pre-existing conditions. To better understand this important protection, it is important to go back to 2010 and beyond to understand what insurers had in place and used.

Definitions: Most insurance companies use one of two definitions: “Objective standard” definition. Pre-existing conditions are conditions in which the patient was already receiving medical advice or treatment before enrolling in a new health plan. In the broader definition of “smart person”, a pre-existing condition is anything for which symptoms exist and a sane person would have sought treatment.

Pre-ACA/Obamacare: State law sometimes restricted which definitions could be used.

Ten states did not specify either definition, 21 called for a “wise person” standard, and 18 called for an “objective standard.” Every state, every insurance plan can make its own decisions.

What this actually looked like: Each state can determine the maximum pre-existing disease exclusion period. If a condition is deemed to be “pre-existing,” the state’s pre-determined maximum waiting period or exclusion period before compensation for pre-existing condition applies. This period was 6 months in Oregon, Massachusetts, and New Mexico, 10 years in Indiana, and unlimited in 10 other states. Idaho was part of a large group of states (23 states) with exclusion/waiting periods of up to 12 months. Essentially, if a pre-existing condition is identified at the time insurance is purchased, when completing a medical history at enrollment, or upon request, the insurance plan applies a exclusion exclusion for that diagnosis for up to 12 months. To do. (Example: A patient had cancer two years ago. She got a new job and a new insurance policy that may not allow cancer treatment coverage for up to 12 months. )

There was an additional “look-back period”/date range where the insurance could look into pre-existing conditions and deny or delay payment. Some were based on the size of commercial insurance plans. (Example: 2-50 employees had more restrictions than larger groups.)

Part 2 compares protections under current law, the Affordable Care Act/Obamacare, to what they were before the law came into force.

We outline protective measures with updated numbers of Americans with pre-existing conditions, including a group of patients recovering from COVID-19.