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Did you know that more than 50 million people in the United States were affected by preexisting conditions in 2016! What does this mean for them?
In the United States, a pre-existing medical condition refers to a medical condition that existed before a person's health insurance began. Before 2014, some insurance policies would deny medical expenses due to pre-existing medical conditions, which prevented many people from obtaining necessary medical services due to illness. With the passage of the Patient Protection and Affordable Care Act, this practice is no longer allowed. According to a report by the Kaiser Family Foundation, more than 52.5 million adults, or 10 percent of U.S. adults, were affected by preexisting conditions in 2016. What exactly does this mean for their lives and health?
Pre-existing medical conditions are defined as medical conditions that occurred before the health benefits plan was in effect. According to President J. James Rohack of the American Medical Association, such exclusion is actually a "rationing of medical services."
Under U.S. law and regulations, preexisting conditions can be classified based on the presence or absence of symptoms. Generally, there are two definitions adopted by insurance companies. One is the "objective standard", which refers to any condition for which the patient has received medical advice or treatment before the new medical insurance plan takes effect; the other is the "prudent person's standard". It includes any situation in which a prudent person would seek treatment if symptoms were present.
Most state laws require insurance companies to choose a "prudent man's standard" to ensure the rights and interests of consumers. According to the Kaiser Family Foundation, about 25% of adults under the age of 65 faced this situation in 2016.
Current Federal Regulations and Their Impact
Under the Patient Protection and Affordable Care Act signed into law on March 23, 2010, the exclusion of pre-existing medical records was prohibited in all health insurance plans as of January 1, 2014, a long-standing The desired reforms. For those with pre-existing conditions, this means no longer being bound by their past illness when getting health insurance.
Under policy, all individual and group health insurance plans must provide coverage, including coverage for domestic violence, without regard to prior medical history.
Past norms and challenges
Prior to the Patient Protection and Affordable Care Act, states had some freedom to regulate the exclusion of preexisting conditions. As early as 1945, the McCarran-Ferguson Act had delegated regulatory power to the insurance industry to the states. Until the introduction of the McAllen-Ferguson Act, many insurance companies were very strict about pre-existing medical conditions. The move puts many people with pre-existing conditions at risk of difficulty obtaining health insurance.
These practices are undoubtedly extremely detrimental to people trying to find insurance protection, causing many people in need of medical services to fall into trouble because they cannot afford them.
Influence people’s feelings
Many advocates oppose such regulations, arguing that they unnecessarily prevent patients in need from accessing care. Spokespersons for insurance companies such as State Farm said they are aware of the shortcomings of this approach and hope to change this situation. The study points out that the limitations associated with pre-existing conditions are not just monetary concerns, but also include patients' basic human rights and health needs.
According to Consumer Watchdog's Director of Health Policy, "Insurance companies want to collect premiums without taking on any risk," which is a profound policy mistake.
Legal Commentary and Public Opinion
Many legislators have expressed distinct views on this topic. For example, the 44th President of the United States, Barack Obama, pointed out in his speech that the problem of covering pre-existing medical conditions will become increasingly serious and can only be saved through major reforms. These are the people who are affected.
According to one survey, about 80% of Americans support requiring insurance companies to cover policyholders even with pre-existing medical conditions. This shows that most people want to see a more equitable health insurance system.
Does today's medical system provide adequate protection for people with pre-existing medical conditions? Now this issue still needs to be thought about urgently. How do you think relevant policies should be further improved?
