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Question of the Week: I have a “pre-existing condition” because I had a joint in my leg fixed from a sports injury. Since the repair has been made and no additional work is required, I think it is unfair that this is considered a pre-existing condition that makes me ineligible for insurance that I can afford. Is there anything in heath reform to address this?

Yes. The Patient Protection and Affordable Care Act includes landmark reforms that will vastly improve access to health coverage for people with so-called “pre-existing conditions.” By 2014, insurers will no longer be allowed to refuse to sell a policy to anyone, regardless of their health status, age, or any other factor. And, they won’t be able to exclude people’s pre-existing conditions from their policies when they do sell them a plan. So, for example, an insurer would no longer be allowed to only offer you a policy that excludes coverage for any care for the leg you injured in the past. Regarding affordability, insurers will also be prohibited from charging people higher premiums because they are in less-than-perfect health. People with pre-existing conditions will therefore be charged the same premiums as people who don’t have any current or past health problems or injuries.

In the years leading up to 2014, people with pre-existing conditions will find that under the Affordable Care Act, they have more options and protections than they had before the new law took effect. A new insurance plan, called the Pre-Existing Condition Insurance Plan or PCIP in most states, is available to people with pre-existing conditions who have been uninsured for at least 6 months. (This is a new option that in many states is available in addition to the high-risk pool plans that were already available for people with pre-existing conditions before the new law took effect.) Premiums for the PCIP are the same as the premiums that healthy people would be charged for the same plan. Information about the PCIP is available online at and Additionally, starting this year, insurance companies will no longer be permitted to deny coverage to children up to age 19 based on their pre-existing conditions or to sell them policies that exclude coverage for their pre-existing conditions.

Finally, new consumer protections that take effect starting this year will protect people with pre-existing conditions who are enrolled in private insurance plans. A protection against unfair rescissions—an abusive practice in which an insurer revokes an individual’s coverage, usually right when an expensive claim is filed, based on an error in the individual’s application for coverage—will make sure that coverage is there for people when they need it. And, a prohibition on lifetime dollar limits and new restrictions on annual dollar limits in coverage will make sure that people don’t “run out of coverage” when they are sick and need it most. To learn more about these protections, visit:

Claire McAndrew is a Health Policy Analyst at Families USA, a nonprofit, nonpartisan organization striving to achieve quality, affordable health coverage for all Americans. For more information, visit

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