The Struggle to Bury Pre-Existing Condition Consideration

Saint Louis University Journal of Health Law and Policy, Vol. 7, No. 2, pp. 405-14 (2014)

University of Washington School of Law Research Paper No. 2014-32

11 Pages Posted: 1 Oct 2014 Last revised: 27 Apr 2016

See all articles by Sallie Thieme Sanford

Sallie Thieme Sanford

University of Washington - School of Law; University of Washington - School of Public Health

Date Written: September 25, 2014

Abstract

As of January 1, 2014, applicants for comprehensive health insurance do not face questions about their health history. The ACA prohibits health insurers from considering an individual’s health history in determining whether to sell that person a comprehensive health insurance policy, the policy’s price, or its coverage terms. Pre-existing condition (PEC) consideration is, in this crucial context, dead. Few will mourn its passing. This legislative milestone marks a significant step towards the goal of a healthier population.

While celebrating this achievement, however, in this article I argue that we ought to recall the context of PEC consideration, its practical application, and its continuing potential to infect other aspects of health care coverage. The “struggle for the soul of health insurance” continues, decades after its description in Deborah Stone’s influential article. With the ACA’s reliance on private insurance, albeit under a much different regulatory framework, competitive pressures to favor the healthy will persist. Moreover, enforcement of the new regulatory framework will be hampered by the ACA’s complex and contentious federalism dance. Vigilance will be required to ensure that those made vulnerable by illness or injury are not further disadvantaged by other key aspects of insurance, such as coverage exclusions, benefit decisions, and provider networks. Access to health insurance is only the beginning.

Keywords: ACA, Health Reform, Pre-Existing Condition, Federalism, health insurance

Suggested Citation

Sanford, Sallie Thieme, The Struggle to Bury Pre-Existing Condition Consideration (September 25, 2014). Saint Louis University Journal of Health Law and Policy, Vol. 7, No. 2, pp. 405-14 (2014); University of Washington School of Law Research Paper No. 2014-32. Available at SSRN: https://ssrn.com/abstract=2501484

Sallie Thieme Sanford (Contact Author)

University of Washington - School of Law ( email )

William H. Gates Hall
Box 353020
Seattle, WA 98105-3020
United States

HOME PAGE: https://www.law.washington.edu/directory/profile.aspx?ID=261

University of Washington - School of Public Health

Seattle, WA
United States

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