Journalism in the Public Interest

Insurers Denied Health Coverage to 1 in 7 People, Citing Pre-Existing Conditions

The nation’s four largest for-profit health insurers denied coverage to more than 651,000 people over a three-year period, citing pre-existing conditions, according to an analysis of insurer data detailed in a Congressional investigation.

Between Aetna, Humana, UnitedHealth Group, and WellPoint, that averages out to a denial of coverage for one out of every seven applicants, according to an Energy and Commerce Committee memo about the investigation.

The memo, released by Energy and Commerce Chairman Henry Waxman and Bart Stupak, both Democrats, touts provisions in the health care reform bill that address pre-existing condition denials.

But all politics aside, the investigation contains some interesting figures and information culled from thousands of pages of documents provided by the insurers. The memo points out, for instance, that since 2007, the number of denials on the basis of pre-existing conditions has risen each year, outpacing the increase in applications for insurance coverage:

A year-by-year analysis shows a significant increase in the number of coverage denials each year. The insurance companies denied coverage to 172,400 people in 2007 and 221,400 people in 2008. By 2009, the number of individuals denied coverage rose to 257,100.Between 2007 and 2009, the number of people denied coverage for pre-existing conditions increased 49%. During the same period, applications for insurance coverage at the four companies increased by only 16%.

Individuals were denied coverage based on “an extensive list of medical conditions,” the memo noted. One company had a list of more than 400 medical diagnoses used to decline coverage to those seeking it, and common conditions such as pregnancy, diabetes, and heart disease were included on the list.

As we’ve noted, under the health care reform bill, insurers are no longer able to deny coverage to children on the basis of pre-existing conditions, but this does not get extended to all age groups until 2014.

A spokesman for Aetna did not dispute the memo’s findings, but told The Wall Street Journal that they “document what many health insurers, including Aetna, have been saying for years – that the individual market needs to be reformed so we can improve access for all consumers.”

For more, read the full memo [PDF].

You can make statistics say anything you want.  I would be willing to bet that more than 7 x 652,000 people had insurance during this time frame.

Why don’t you provide all the numbers so people can really tell what you are trying to say.

1, how many people were insured during that time frame (year by year).
2, how many of the people were reapplying and being denied for the same reason.
3, how many people received new coverage with those insurance companies during the time frame (don’t limit to just the individual market, include the group market).

I would bet that the number of denials due to preexisting conditions of all eligible insureds is less than 1%.


I am uninsured because I have diabetes and no insurance companies will cover me. 

Next time you need to check your facts better or STFU0

privat Health insurance in this country is not about helping people but making profit in case you haven’t noticed that. If your health condition is in the way of the insurance company making more profit,  you willlllll alwayyyyyyys lose.
This is what republican politics is all about! That is why they protect the status quo!
good for billionaires, bad for ordinary people!

It’s still a confusing article. I have a pre-existing condition for which I can’t get insurance. But I still have ‘health insurance.’ The pre-existing condition is not covered, but everything else is.

I think there are many people in this boat.

In the article above, would I be one of the people that was ‘denied coverage’?

Mr. Little, I would like to check the facts but there are very few in this article.  That is my point.  This headline is designed to make you even angrier because of the large number of denials.  Make it look like there is an epidemic of coverage denials, but I think there are really very few and I would like better numbers to show that.  All of which has nothing to do with the fact that you are uninsured.

You are uninsured because you do not meet the standards of insurability.  It is like trying to buy car insurance after the car has been wrecked.

Bob, did you read the entire memo?  You probably still won’t be satisfied because yours is the strawman “wrecked car” political argument trotted out smugly by the opponents of more widely available insurance. 

The very concept of insurance is to pool the risk.  Cutting the risk pool into ever smaller slices is an idea only the currently insured or healthy me-firster could love.  Each of us is only one melanoma or aneurism away from the disaster you disdain so vehemently in the “uninsurable.”

I must admit I had not opened the pdf, but once again.  The headline says 1 in 7 people denied for pre-existing conditions.  But that only applies to the individual market and ignores the massive amount of people who were accepted for insurance. 

I have now read the memo and I still did not see the numbers I was looking for and still stand behind the statement that you can make statistics say anything you want.

Gloria, your definition of insurance seems pretty accurate, and you are right, I am currently insured and fairly healthy.  However, I still have been insured all my life, paying for many peoples illnesses and injuries who are also paying for insurance and not necessarily vary healthy. 

I missed the part of the insurance definition where you cover the expense of people who were never in the risk pool.  This seems more like charity. 

Now all the people who were previously denied coverage because they are already sick will be allowed into the pool and the costs for everyone in the pool will go up.  As far as I can see, nothing has been done to help make all of us healthier and lower the overall cost of healthcare.  Nothing has been done to change the delivery of healthcare to make it so the treatment of the disease is more important than the number of times you come in for a visit or the more test you run.

The real winners in the healthcare reform bill was the insurance companies and the healthcare professionals.  Because both will be getting more people to contribute to their industry.

Health Care Business is a monopoly and should be regulated so that every insurance company play by the same provisions.
You know your congress does not get individual plans, but a Federal plan which is run by the strongest union,Congress.

Under their plan no one is dump and they get to keep it for live and never can go bankrupt.Sounds like socialize medicine for the powerful.

But I am willing to meet you half way. Let me pay my way into Medicare (actual fee not subsidize) so they can make a profit and you stick with your health companies.

As the mother of two type 1 diabetic children, I am forced to have a “regular” job in order for them to receive medical insurance.  Both were diagnosed when I had my own business and both were denied further coverage on my individual insurance policy when it was up for renewal.  The insurance companies were more than willing to give my husband and I (both healthy) individual policies but there were no takers for my children (at any cost, in case someone throws that out there).  My choice was to get a paycheck from someone else, become destitute paying for medical expenses out-of-pocket or become destitute paying for the state-provided “high-risk” insurance that wasn’t much cheaper than the out-of-pocket choice.

And now that there is a regulation protecting children like mine from the greedy policies of the insurance companies, those same insurance companies are threatening to stop offering ANY coverage to children to skirt the regulation.  My children will have issues with insurance their entire lives if the greedy Republicans succeed in their effort to repeal the very necessary healthcare reform bill.

I, too, have had insurance most of my adult life, as has my husband.  We use the preventative care.  The insurance companies have only made money on us.  Healthcare should not be a for-profit enterprise.  Greed should not have an impact on who gets care and who does not.

It is likely many people “denied” insurance were covered by plans already but “shopped” to get lower rates.  I know, because my wife was one of them. Fortunately, we live in a state (MD) that already has a “public option” so we could migrate seemlessly from a very high-deductible plan to a much lower one with lower premiums. 

She had been denied coverage in the “individual market” for her medical conditions. It is important people are aware this can ONLY happen in the “individual” or non-group market.  Federal legislation back in 1997 under HIPAA BANNED insurers from denying coverage to “timely enrollees” for group (employer/union sponsored) medical insurance for medical history.  It also created “portabaility” between group to group transfers of coverage to prevent insurance “job lock.”  Keep in mind, this was 13 years ago.  Unfortunately, too many people paid little or no attention to these provisions or their rights under them and effectively forfeited these important protections.

Congress could have easily and long ago fixed the big part left out of HIPAA:  Portability from group to individual market insurance or from on individual market plan to another.  But they chose not to.  You cannot blame individual market insurers for this/

Congress could have also required “guarantee issue” for individual coverage, just as HIPAA in 1997 guaranteed your acceptance for an employer-sponsored plan.  The cost of guarantee issue is not as great as one might think.  One insurance company executive told me that after about 32-months, the claims experience for a guarantee issue risk pool and one heavily underwritten (screened for uninsurables) was indistinquishable.

It is folly often devolving to demagoguery to mindlessly rail against the insurance industry when in fact, they are simply parties who finance care based on the rules required by the federal govt. and the states.  These same insurers will be more than happy to operate on guaranteed issue across the board IF they are able to charge premiums appropriate to the risk. 

As Lloyds of London demonstrated years ago, there is virtually no risk that cannot be insured against.  The only question is, what is the premium?

What remains to be seen with PPACA (aka Obamacare) is if meaningful mechanisms will be allowed to keep otherwise honest citizens from “gaming” the system by enrolling for coverage if and only when they expect to need care, then dropping out when they don’t.  So far, there doesn’t seem to be anyway of policing this in current reform. Without protections against “anti-selection”
reform is doomed, unless of course, govt. wants to continue to borrow to subsidize costs for the less able or less responsible.

I agree that you can make statistics say anything. I think that one out of seven people being denied is way too low of a number. As an agent in Utah, I would say that probably 3 out of 7 people, if not 4 out of 7 people are denied because of pre-existing conditions.

Jared B.

Do you really think you’re going to get free health insurance and all the best care for your every need with the Obama Health Plan?  You may have to wait for years for treatments for cancer, etc. and possible die while your playing the waiting game for your needed treatment!!  If you truly understood what is actually stated in this plan you would run in the opposite direction.  Listen…this is only going to hurt us in every way!!  There are other ways to get a health plan even if you have preexisting conditions.  Be smart and research Obama’s plan and other agenda issues, don’t just believe what is written or said to you…investigate it as if it will make the biggest and most dangerous change in your life you could ever imagine.  Think about it and use your mind to find the TRUTH!!

lol@scott qualls
Sounds like you’re the one that needs to do some reading. And not from right wing teaparty extremists.

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