The Sensible Solution for Pre-Existing Condition Exclusions

The problem of individuals being denied health insurance because of a pre-existing medical condition is frequently cited by defenders of Obamacare as justification for the law, particularly its new insurance regulations and individual mandate.

In truth, however, the problem is actually much smaller than portrayed, and a sensible solution does not require anything like the massive new spending, taxing, and insurance market takeover included in Obamacare.

In the group market, where over 90 percent of Americans with private health insurance are enrolled, there are reasonable rules limiting the application and duration of pre-existing condition exclusions. For employment-based coverage, a pre-existing condition exclusion can only be imposed if an individual has less than 12 months of prior coverage. Furthermore any coverage exclusion can be for no more than 12 months—or 18 months if the individual didn’t enroll in the employer plan when first eligible.



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