Raising Women’s Voices

The Pre-Existing Condition Problem

Posted in Affordability, Health Disparities, Pre-existing conditions by raisingwomensvoices on February 26, 2009

In 44 states, insurance companies are legally allowed to deny coverage, or charge more, to individuals with pre-existing conditions. Today, most Americans receive health insurance through an employer’s group rate, which cannot deny or charge more to those with pre-existing conditions. However, with the climbing unemployment rate, the number of Americans who get their coverage in individual or family rates will climb, as well. This will leave many with pre-existing conditions either untreated or in debt because of the higher rates.


Adding an infant or another medically expensive individual to a group rate can cause premiums to rise for all employees. So when her employee Kathy Fisher had a son, Nicholas, Shelly Yanoff of Philadelphia Citizens for Children and Youth (an organization that, ironically, works to get health insurance for children) decided to put Nicholas on an individual plan assuming it would be cheaper. Because of a jaundice at 5 days old, Aetna rejected him, claiming, “We couldn’t price a policy in a range that anybody could actually pay for. If we can’t price affordably, we don’t accept”.

The rejection of a five-day-old highlights the problems, specifically involving pre-exisiting conditions, with our health system. As President Obama said at Tuesday’s joint session, we need “quality affordable health care for every American”. To achieve this, we must end rules that allow insurance companies to exclude inviduals based on pre-existing conditions. A costly decision, but a necessary one.

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sara siegel

One Response

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  1. Priscilla said, on July 10, 2009 at 2:09 pm

    My son was denied coverage by United Healthcare Partners because he had had (no longer had) jaundice at 4 days after birth. My pediatrician believes that this is a ridiculous ruling given the rate of newborn jaundice and the fact that there is no medical consequence from it. Does anyone know of there is something we can do to fight this?

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