Living with a pre-existing condition in a time of uncertainty
By Erin W., Leawood, Kansas
I never envisioned that a minor, short-lived medical incident would impact my access to health care for the rest of my life.
In 2005, my husband and I decided that it would be best for our family if I were to stay home with our kids. We talked to an insurance agent and determined there were affordable family plans available on the market, as we previously received insurance through my work. However, after completing the application process, we were shocked to learn that I (a healthy, non-smoking individual who rarely drank and exercised regularly) was branded as having a pre-existing condition due to a minor, short-lived medical event that occurred in 2001 after my first pregnancy.
The insurance company I applied with refused to cover me under the family plan. In fact, they would not cover me under an individual plan. I was simply denied coverage. Feeling uneasy, I filled out another 10-page application with a different insurance agency. I was denied again. In both applications, I appealed to these companies with a letter from my doctor, explaining that there was zero expectation of the medical event reoccurring and that I was very healthy. But the words of a medical expert meant nothing.
I felt helpless learning that I was uninsurable. It made me feel as if there was something wrong with me. And it was frustrating to realize that insurance companies and health care costs could be the determining factors in whether I could actually make decisions that were in the best interest of myself and my family.
Finally, with my doctor’s letter in hand, I went to one more insurance company. Thankfully, I was able to get coverage, but my premiums were very expensive. In fact, my individual premiums were higher than the family plan that covered three people. My coverage was also subpar. For instance, while the family plan covered things like immunizations, prescriptions, and preventative care, mine did not.
Even though I was now insured, I found that I was reluctant to go to the doctor for preventative care, as I had to pay the full cost out of pocket. I was also hesitant due to the possibility of a routine exam revealing another pre-existing condition, potentially resulting in increased premiums or dropped coverage. The bottom line is that I often found myself apprehensive about seeing a doctor. I don’t think this is a healthy way to go through life. I believe preventative care is important and the old insurance system often discouraged people from seeing a doctor at the onset of a problem, often resulting in more expensive emergency treatment.
That’s why I was so thankful when the Affordable Care Act (ACA) passed. I finally had affordable coverage that included preventative care and prescriptions. My individual premiums were also significantly less than our family plan, which is how it should be. Also, just as my doctors indicated to the insurance companies, I have never needed medical care related to that 2001 medical event — not once in 16 years.

Over the course of eight years under the pre-ACA insurance, I paid $44,000 in premiums and basic preventative care costs, while the insurance company didn’t pay a dime. All that time, I could have been covered under our basic family plan, but the insurance companies had the freedom to decide that I had a pre-existing condition. I wish we could have that $44,000 back to help pay for college for my two children.
The uncertainty surrounding the possible repeal of the ACA and its potential replacements is awful. I don’t want to go back to subpar coverage and super expensive premiums. And I find myself again worrying about going to the doctor or getting a mammogram. What if I encounter a new pre-existing condition? What if this time I can’t find an insurer that will cover me? Just the other day I found myself hesitant to give a new doctor my full medical history. I was concerned about having that 16 year old medical diagnosis highlighted in my most recent medical records. There is absolutely no reason someone should ever be concerned about providing their medical history to a doctor, but that was my experience.
Originally published at www.ofa.us.

