Pre-existing Conditions in Wisconsin: Health Insurance Matters

America is debating the role of pre-existing conditions in its health insurance programs. Again. In 2014, the Affordable Care Act (ACA) protected individuals with pre-existing conditions from being excluded from coverage. These protections may be weakened through changes to the ACA, such as short-term plans. After a visit to Madison, Wisconsin and the Bucky Badger statues at the state capitol building, let’s use Wisconsin as an example.

Why Wisconsin? It reflects many states in the U.S. Of nearly six million residents, 93 percent have health insurance. More than half (56%) have employer coverage, 30 percent have Medicaid (16%) and Medicare (14%), and 7 percent have non-group, individual, and other coverage. The remaining seven percent are uninsured. (1)

What is a pre-existing condition? It is an illness, injury, or physical condition that began before the effective date of coverage. Prior to 2014, insurance carriers could exclude people from all coverage or coverage for the specific condition. Examples include cancer, heart disease, mental health and substance abuse issues, and pregnancy.

How many Wisconsinites are affected by them? Kaiser Family Foundation’s recently released data estimated that 27 percent of the non-elderly (18-64 years) adults in the “Milwaukee-Waukesha-West Allis, WI” Metropolitan Statistical Area have a pre-existing condition. (2)

Who might be affected? Here are a few people who might be affected if insurance carriers exclude those with pre-existing conditions:

  • The waitress at a “farm to table” restaurant who is pregnant
  • The middle-aged man at a local fundraiser who needs a cane to walk
  • The young boy playing on the Bucky Badger statue who wears a protective helmet
  • The student at University of Wisconsin who uses a wheelchair to get around campus

How much do pre-existing conditions affect insurance premiums? A lot. Premiums are less when people with pre-existing conditions are excluded from coverage. But these individuals would be forced to pay for their health care out of their own pockets.

Why so much? Let’s assume we have 10 people. If seven are healthy and three are unhealthy (i.e., 27% of Wisconsinites), individual premiums might be $30,000 per year. If individuals with pre-existing conditions are excluded, premiums may drop to $1,000. They will increase again when someone with coverage gets sick. (3)

What else? If you get a chance, visit the 85 Bucky Badger statues throughout Dane and Madison counties. They are “on parade” until September 12, 2018. It’s free and fun for all. BTW, five had to visit the “statue hospital” to be repaired after a summer storm. Will their pre-existing conditions be covered in the future? Let’s hope so. (4)

Sources:

(1) Kaiser Family Foundation (2016 state data)

(2) Kaiser Family Foundation (“News Analysis Maps Prevalence of Pre-Existing Conditions by Metro Area” dated 8/28/2018)

(3) ClareFolio’s Dinner Table Calculator

(4) Channel 3000 News