Report: Almost One in Four Non-Elderly Oregonians Have Diagnosed Pre-Existing Health Conditions

A New Report From Families, USA Reveals 794,000 Non-Elderly Oregonians Will Gain Protections from Health Reform Law Prohibiting Insurance Coverage Denials and Discriminatory Premiums

Washington, D.C. – Approximately 794,000 Oregonians people under the age of 65—almost one in four (24.7 percent) of Oregon’s non-elderly population—have a diagnosed pre-existing condition that could lead to a denial of coverage in the individual health insurance market, according to a report released today by the consumer health organization Families USA. They are among the 57.2 million people nationwide who could potentially face discriminatory health coverage practices.

Once the newly-enacted health reform law is implemented, these Oregonians will gain significant protections: The new law prohibits insurance companies from denying health coverage to people due to pre-existing conditions; from charging discriminatory premiums based on health status; and from excluding benefits that would treat their health conditions.

The report shows that, while individuals in all age groups in Oregon have pre-existing health conditions, this is a problem that grows with age:

* More than one in six (16.8 percent of) young adults aged 18 to 24 have a diagnosed pre-existing health condition that could lead to a denial of coverage.

* Nearly two in five (37.8 percent) of adults aged 45 to 54 have a diagnosed pre-existing condition that could lead to a denial of coverage.

* In the 55 to 64 age group, the portion of adults with diagnosed pre-existing conditions climbs to nearly half (47.2 percent).

* Although the portion of children under 18 years of age with diagnosed pre-existing conditions is low compared to adult groups, there are 61,300 children in Oregon with such conditions.

“The thousands of Oregonians with diagnosed health conditions, and the many others who at some point may receive such a diagnosis, are the people most in need of health care coverage,” said Ron Pollack, Families USA’s Executive Director. “Thankfully, the new health reform legislation will protect all these individuals from the most harmful insurance company abuses that deny such critical coverage.”

In its analysis, Families USA indicates that the its totals may understate how many people nationally and in Oregon have pre-existing conditions, because the analysis only reflects those with diagnosed pre-existing conditions. Americans who are currently uninsured or underinsured, and who cannot afford care, often do not seek treatment and, as a result, their health condition may not be diagnosed.

The uninsured and those who do not have access to job-based coverage are at greatest risk; however, even those who now have coverage at work could be at risk if they lose or leave their jobs and have to find coverage in the individual market.

Income is no protection against an individual’s having a pre-existing condition that could lead to a denial of coverage, and the 794,000 Oregonians with diagnosed pre-existing conditions range across all income levels.

* The lowest-income Oregonians are most likely to have a pre-existing condition. More than one-quarter (28.0 percent) of those individuals in families with incomes below 100 percent of the federal poverty level—less than $22,050 for a family of four—are affected.

* Approximately 22.5 percent of individuals in Oregon families with incomes between 100 and 199 percent of poverty—between $22,050 and $44,100—are affected.

* While the lowest-income Oregonians are slightly more likely to be affected by pre-existing conditions, more than two-thirds (69.4 percent) of those with pre-existing conditions that could lead to a denial of coverage are middle class and higher-income Americans. These are individuals in families with incomes above 200 percent of poverty, or more than $44,100 for a family of four in 2010.

Individuals in every racial and ethnic group in Oregon have diagnosed pre-existing conditions that, absent reform, could lead to a denial of coverage.

* More than one-quarter (26.3 percent) of non-Hispanic whites have pre-existing conditions.

* More than one-quarter (29.7 percent) of African Americans (non-Hispanic) have such a condition.

* Approximately one-quarter (25.6 percent) of American Indians and Alaska Natives are affected.

* Nearly one in five (17.6 percent of) Hispanics are affected. It is important to note, however, that disparities in access to care and in the delivery of care may mean that many individuals have a pre-existing condition that has not been diagnosed. For example, previous research shows that at the national level more than a quarter (25.2 percent) of Hispanic adults had no health care visits in 2007, compared to 14.7 percent of non-Hispanic adults.

“As our study shows, nearly one-quarter of the non-elderly population of Oregon will now gain protections that they need to secure affordable health coverage,” said Pollack. “As more and more people learn about these protections, they will no doubt cherish the enactment of health care reform.”

The data for the report were based on data on health conditions from the federal Medical Expenditures Panel Survey and demographic data from the U.S. Census Bureau’s Current Population Survey (CPS). Families USA commissioned The Lewin Group to analyze the data.

The report for Oregon with an analysis of the groups with pre-existing conditions in that state can be found at http://www.familiesusa.org/assets/pdfs/health-reform/pre-existing-conditions/oregon.pdf

A full description of the report’s methodology can be found in the Technical Appendix of the national report, available at http://www.familiesusa.org/assets/pdfs/health-reform/pre-existing-conditions.pdf