News Release

New Analysis Maps Prevalence of Pre-Existing Conditions by Metro Area

In Some Areas, Nearly 4 in 10 Adults Would Likely Be Denied Individual Insurance Coverage Based on Pre-ACA Guidelines Or Under Short-Term Plans

A new Kaiser Family Foundation analysis maps rates of pre-existing conditions across 129 metropolitan and micropolitan areas in the U.S., finding that even within the same state, the prevalence of such conditions can vary substantially.

For example, 34 percent of residents of Florence, South Carolina have a pre-existing condition, but further south in Charleston and Hilton Head, the rate is 24 percent.

The share of non-elderly adults with a pre-existing condition ranges from 41 percent in Kingsport, Tennessee to 20 percent in Logan, Utah and Rochester, Minnesota.

A previous KFF analysis showed that nationwide, 27 percent of adults age 18-64 have a pre-existing condition that would have led to a denial of individual market insurance coverage prior to the ACA. Since 2014, the law has prohibited individual market insurers from denying coverage due to a current or past diagnosis of a so-called “declinable medical condition,” such as cancer, diabetes, heart disease, or pregnancy.

While many people with pre-existing conditions obtain health insurance through an employer or through a public coverage option like Medicaid, these new estimates suggest that in some areas, many adults would be ineligible for individual market insurance under pre-ACA medical underwriting practices if they were to lose their current coverage.

The Trump administration has continued to pursue policy changes that would weaken protections for people with pre-existing conditions, including expanding the availability of short-term insurance plans, which are exempt from ACA-required coverage requirements, including guaranteed access to insurance for people with pre-existing conditions. Several states have responded with legislation restricting or effectively banning such plans.

The ACA is also being challenged in court by a group of state attorneys general who argue that the individual mandate is unconstitutional, and the law should therefore be overturned. The Trump administration has filed a brief in the case agreeing that the individual mandate is unconstitutional, and arguing that the ACA’s pre-existing condition protections should be invalidated.

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The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.