Health Insurers Do End Run around Requirement to Cover Pre-Existing Conditions

Friday, September 19, 2014

Legally, insurance companies can’t deny health coverage to individuals with pre-existing medical conditions under Obamacare. But the adoption of legislative mandates doesn’t always ensure complete or even partial change on the part of an industry, and the pre-existing requirement included in the Affordable Care Act is no different.


Instead of just outright rejecting patients seeking insurance coverage, health plans are punishing those with existing, and serious, conditions by making them pay more for their drugs.


Those affected include people suffering from illnesses like Parkinson's disease, diabetes, migraine headaches, hypertension, hepatitis C and epilepsy, ProPublica and The New York Times found.


Internally, insurers are classifying both brand name and generic drugs as “non-preferred,” which results in all drugs for these patients costing more money through higher co-pays. This effectively drives patients away from a plan because it is too expensive, but the insurer gets away with legally claiming it does not discriminate against those with pre-existing conditions.


One health expert, Dr. A. Mark Fendrick, a physician and director of the University of Michigan Center for Value-Based Insurance Design, told ProPublica that if insurers are allowed to deny patients cheaper drug alternatives, some Americans will decide to stop taking their pills because they can’t afford them.

-Noel Brinkerhoff


To Learn More:

A New Way Insurers are Shifting Costs to the Sick (by Charles Ornstein, ProPublica)

Is All “Skin in the Game” Fair Game? The Problem With “Non-Preferred” Generics (by Gerry Oster and A. Mark Fendrick, American Journal of Managed Care)

Billions Wasted as Medicare Turns Blind Eye to Excessive Brand-Name Drug Prescriptions (by Noel Brinkerhoff and Danny Biederman, AllGov)


bckrd1 9 years ago
we need single payer. Should have gone with a Republican proposal to give the ins comp 5 years to get their act together or go public option.
Ed 9 years ago
Once you are a scumbag you rarely will change and the insurance industry is among the worst scumbags ever. Perfect example of why a single payer system should be adopted or it you want to see real competition make medical insurance illegal and then watch the price of Doctor, Hospital and Drugs drop dramatically.

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