KFF: 27% of non-elderly U.S. adults have pre-existing conditions that would have been declined without ACA

A new analysis found nearly 54 million non-elderly people have a pre-existing condition that would have been declined before the Affordable Care Act went online. (designer491/Getty)

Nearly 54 million people under 65 have a pre-existing condition that would have been declined before the Affordable Care Act (ACA), according to a new analysis.

A new analysis from the Kaiser Family Foundation (KFF) released Friday comes as the fate of the ACA is in doubt while a federal appeals court decides on a constitutional challenge from Texas and several other red states.

KFF found 27% of the U.S. population under 65 years old have a pre-existing condition that would have made them uninsurable before the ACA went online in 2014. The share of adults with such pre-existing conditions varies from state to state.


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For instance, 37% of non-elderly adults in West Virginia had a pre-existing condition that could be declined, alongside 34% for Arkansas, Kentucky and Mississippi. However, 22% of the Colorado population had such a pre-existing condition.

“Almost half (45%) of non-elderly families include at least one adult with a medical condition who might not be able to buy individual insurance without the ACA’s prohibition of medical underwriting,” KFF said.

A majority of people with pre-existing conditions are covered through an employer or a public program such as Medicaid.

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KFF’s estimate is based on 2018 data from two large government surveys.

The analysis comes as the Fifth Circuit Court of Appeals is weighing a decision on the lawsuit Texas v. Azar, which seeks to overturn the entire ACA.

A group of 18 states led by Texas and supported by the Justice Department argue in the lawsuit that the repeal of the ACA individual mandate as part of tax reform means the rest of the law cannot survive. A collection of 17 attorneys general and the District of Columbia is fighting the lawsuit.

A federal judge agreed with Texas that the law should be struck down. A panel of three judges as part of the Fifth Circuit Court of Appeals held an appeals hearing in July on the lawsuit, but a decision has not been rendered.

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