What Is A Pre-Existing Condition?

On Thursday, the revamped American Health Care Act cleared the House and headed to the Senate, leaving millions of Americans worried about the future of their health care. One of opponents' biggest criticisms of the bill is that it would no longer guarantee affordable health insurance to those with pre-existing conditions, meaning many Americans could be excluded from accessible health care under the AHCA. But what exactly is a pre-existing condition, and how justified are concerns over those with pre-existing conditions losing their coverage?

The term is frustratingly vague. According to the Department of Health and Human Services, a pre-existing condition is a "health problem you had before the date that new health coverage starts," or a condition that a person had prior to them acquiring health insurance. What exactly counts as a pre-existing condition, however, varies depending on insurers, since there aren't exactly legal guidelines around defining pre-existing conditions.

The GOP hasn't provided parameters for pre-existing conditions, and unlike the days before the Affordable Care Act, the AHCA will not allow insurers to outright deny coverage to people with pre-existing conditions. However, according to The Atlantic, if the AHCA passes, states will be able to apply for waivers that would let insurers charge higher premiums to those with pre-existing conditions. States with waivers would then receive federal subsidies for these high-risk groups, a move that Republican lawmakers have argued would help protect patients with pre-existing conditions from getting financially gouged by insurers.

Unfortunately, the list of health issues that insurers list as pre-existing conditions is long and varied. According to a review of insurance policies carried out by the Kaiser Family Foundation, before Obamacare went into place, insurers would often automatically deny people coverage if they had any of the following conditions:

Alcohol abuse/ Drug abuse with recent treatment
Arthritis (rheumatoid), fibromyalgia, other inflammatory joint disease
Cancer within some period of time (e.g. 10 years, often other than basal skin cancer)
Cerebral palsy
Congestive heart failure
Coronary artery/heart disease, bypass surgery
Crohn’s disease/ulcerative colitis
Chronic obstructive pulmonary disease (COPD)/emphysema
Diabetes mellitus
Hepatitis (Hep C)
Kidney disease, renal failure
Mental disorders (severe, e.g. bipolar, eating disorder)
Multiple sclerosis
Muscular dystrophy
Obesity, severe
Organ transplant
Parkinson’s disease
Pending surgery or hospitalization
Pneumocystic pneumonia
Pregnancy or expectant parent
Sleep apnea

Even for those who didn't have a "declinable" condition listed above, many had other conditions that could lead to higher rates, increased deductibles, or modified benefits or coverage (as in, the insurer would cover everything but the pre-existing condition's treatment or the insurer would not cover prescription drugs). The list of pre-existing conditions that could earn you that treatment, according to the Kaiser Family Foundation, included the following:

Basal cell skin cancer
Ear infections
High cholesterol
Joint injuries
Kidney stones
Menstrual irregularities
Migraine headaches
Restless leg syndrome
Urinary tract infections
Varicose veins

That's right: something as insignificant as ear infections (raise your hand if your child has ever had an ear infection) or acne (raise your hand if you thought this would end in your teens but didn't) could lead to higher premiums on insurance under the AHCA. Same goes for pregnancy, anxiety, menstrual irregularities, and migraines.

Chances are that if you read through insurers' lists of pre-existing conditions, you'll find a condition that you or a friend has had before. In fact, the Kaiser Family Foundation estimates that nearly one-third of Americans have pre-existing conditions, and 53 percent of Americans report that they — or someone in their home — has a pre-existing condition. Hopefully the GOP's plan to protect people with pre-existing conditions works, because otherwise, a large chunk of Americans will be struggling with the fallout.