| 词条 | Pre-existing condition |
| 释义 |
In the context of healthcare in the United States, a pre-existing condition is a medical condition that started before a person's health benefits went into effect. Before 2014 some insurance policies would not cover expenses due to pre-existing conditions. These exclusions by the insurance industry were meant to cope with adverse selection by potential customers. Such exclusions have been prohibited since January 1, 2014, by the Patient Protection and Affordable Care Act. According to the Kaiser Family Foundation, more than a quarter of adults below the age of 65 (approximately 52 million people) had pre-existing conditions in 2016. DefinitionsThe University of Pittsburgh Medical Center defines a pre-existing condition as a "medical condition that occurred before a program of health benefits went into effect".[1] J. James Rohack, president of the American Medical Association, has stated on a Fox News Sunday interview that exclusions, based upon these conditions, function as a form of "rationing" of health care.[2] Conditions can be broken down into two further categories, according to Lisa Smith of Investopedia:[3] {{ quote| Most insurance companies use one of two definitions to identify such conditions. Under the "objective standard" definition, a pre-existing condition is any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan. Under the broader, "prudent person" definition, a pre-existing condition is anything for which symptoms were present and a prudent person would have sought treatment. }} Which definition may be used was sometimes regulated by state laws. Some states required insurance companies to use the objective standard, while others required the prudent person standard. 10 states did not specify either definition, 21 required the "prudent person" standard, and 18 required the "objective" standard.[4] According to the Kaiser Family Foundation, more than a quarter of adults below the age of 65 (approximately 52 million people) had pre-existing conditions in 2016.[1] Current U.S. federal regulation
Former regulationRegulation of pre-existing condition exclusions in individual (non-group) and small group (2 to 50 employees) health insurance plans in the United States was left to individual U.S. states as a result of the McCarran–Ferguson Act of 1945 which delegated insurance regulation to the states and the Employee Retirement Income Security Act of 1974 (ERISA) which exempted self-insured large group health insurance plans from state regulation. After most states had by the early 1990s implemented some limits on pre-existing condition exclusions by small group (2 to 50 employees) health insurance plans, the Health Insurance Portability and Accountability Act (Kassebaum-Kennedy Act) of 1996 (HIPAA) extended some minimal limits on pre-existing condition exclusions for all group health insurance plans—including the self-insured large group health insurance plans that cover half of those with employer-provided health insurance but are exempt from state insurance regulation.[8][9][10][11][12][13]
Pre-existing condition exclusions were prohibited for HIPAA-eligible individuals (those with 18 months continuous coverage unbroken for no more than 63 days and coming from a group health insurance plan). Individual (non-group) health insurance plans could exclude maternity coverage for a pre-existing condition of pregnancy.[2] Group health insurance plans sponsored by employers with 15 or more employees were prohibited by the Pregnancy Discrimination Act of 1978 from excluding maternity coverage for a pre-existing condition of pregnancy; this prohibition was extended to all group health insurance plans by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).[2] Practice and effectAdvocates against pre-existing condition rules argue that they cruelly deny people in need of treatment. State Farm spokeswoman K.C. Eynatten has said, "We realized our position was based on gut feelings, not hard numbers... we became aware that we were part of the reason a woman and her children might not leave an abuser. They were afraid they'd lose their insurance. And we wanted no part of that."[19] Jerry Flanagan, health-care policy director of Consumer Watchdog, has stated that "insurance companies want premiums without any risk" and go to extreme "lengths... to go to make a profit".[20] InsureMe, an insurance quote provider website, has argued that even though health insurance is basically to protect people from very high costs of health care, the commercial health insurance system is not playing fair and are always trying to avoid risk in order to boost their profits.[21] Some practices by some health insurance companies, such as determining domestic violence to be an excludable pre-existing condition, have been called abuses by Maria Tchijov, a Service Employees International Union new media coordinator, and by an Office of Rural Health Policy report.[19][23][24] The rationale behind pre-existing condition clauses, according to those who defend the policies, is that they reduce the cost of health insurance coverage for those who still receive it, thus giving more people an opportunity to afford insurance in the first place.[19][26] The San Francisco Chronicle has reported that "[c]osts for those with coverage could go up because people in poor health who'd been shut out of the insurance pool would now be included... they would get medical care they could not access before."[26] Senator Mike Enzi, a Republican from Wyoming, has voted to allow insurance companies to consider domestic violence as a pre-existing condition and supported his vote by saying that covering such people could raise insurance premiums to the point where it would preclude others from buying it. He has remarked that "If you have no insurance, it doesn't matter what services are mandated by the state".[19][29] According to the California-based advocacy group Consumer Watchdog, other possible situations falling under pre-existing condition clauses are chronic conditions as acne, hemorrhoids, toenail fungus, allergies, tonsillitis, and bunions, hazardous occupations such as police officer, stunt person, test pilot, circus worker, and firefighter, and pregnancy and/or the intention to adopt.[20] Commentary by lawmakersAccording to a Reason.com libertarian opinion blog by Peter Suderman, the 'Pledge to America' issued by the Republican Party in September 2010 stated, "Health care should be accessible for all, regardless of pre-existing conditions or past illnesses.... We will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-existing condition."[31] In a March 3, 2010, address, President Barack Obama said that coverage denied to those with pre-existing conditions is a serious problem that would only grow worse without major reforms.[32] In a September 2010 visit with Falls Church, Virginia, residents, Obama referred to a woman with an eye condition and a woman with non-Hodgkin's lymphoma as personal examples in the audience of those benefiting from changing pre-existing condition rules.[33] Public opinionA Time Magazine-Abt SRBI poll in late July 2009 found that a large majority of Americans (80%) favored a requirement that insurance companies insure people even if they suffer from pre-existing conditions. In September 2009, the monthly Kaiser Health Tracking Poll report said:[35] {{quote| The public’s most unanimous and bipartisan support is saved for a proposal to have the federal government require that health insurance companies cover anyone who applies, even if he/she has a pre-existing condition. Overall, eight in ten back the proposal, including 67 percent of Republicans, 80 percent of political independents and 88 percent of Democrats. }} See also
References1. ^{{Cite news|url=https://www.npr.org/sections/health-shots/2018/10/11/656503264/fact-check-whos-right-about-protections-for-pre-existing-conditions|title=FACT CHECK: Who's Right About Protections For Pre-Existing Conditions?|work=NPR.org|access-date=2018-10-12|language=en|date=October 11, 2018|author=Julie Rovner}} [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]2. ^1 {{cite web | date=September 29, 2009 |title=Kaiser Health Tracking Poll—September 2009: Public opinion on health care issues |url=http://www.kff.org/kaiserpolls/upload/7990.pdf |accessdate=January 16, 2010 |location=Washington, D.C. |publisher=Kaiser Family Foundation}} 3. ^1 {{cite web|year=2010|url=http://www.upmc.com/HOSPITALSFACILITIES/FINANCIAL-SERVICES/Pages/billing-terminology.aspx|accessdate=January 16, 2010|location=Pittsburgh|publisher=University of Pittsburgh Medical Center (UPMC)|title=Billing terminology|deadurl=yes|archiveurl=https://web.archive.org/web/20101003092545/http://www.upmc.com/HospitalsFacilities/financial-services/Pages/billing-terminology.aspx|archivedate=October 3, 2010|df=}} 4. ^1 2 3 {{cite news |author=Jacobson, Louis |date=August 18, 2009 |title=Pregnancy a 'pre-existing condition'? Yes, for some |publisher=PolitiFact.com |url=http://www.politifact.com/truth-o-meter/article/2009/aug/18/pregnancy-pre-existing-condition/|accessdate=January 17, 2010}} 5. ^1 {{cite web |author=Smith, Lisa |date=February 16, 2009 |title=Health insurance: paying for pre-existing conditions |publisher=Investopedia|url=http://www.investopedia.com/articles/pf/09/covering-medical-costs.asp |accessdate=January 17, 2010}} 6. ^1 {{cite web|url=https://www.kff.org/other/state-indicator/individual-market-portability-rules/|title=Individual Market Portability Rules (Not Applicable to HIPAA Eligible Individuals)|date=21 July 2014|publisher=|accessdate=8 March 2019}} 7. ^1 {{cite journal |doi=10.1377/hlthaff.13.1.327 |author1=Gabel, Jon |author2=Liston, Derek |author3=Jensen, Gail |author4=Marsteller, Jill |date=Spring 1994 |title=The health insurance picture in 1993: some rare good news |journal=Health Affairs |volume=13 |issue=1 |pages=327–336 |url=http://content.healthaffairs.org/cgi/reprint/13/1/327.pdf |accessdate=February 22, 2010 |pmid=8188152}} 8. ^1 {{cite web |author1=Kassebaum, Nancy Landon |author2=Kennedy, Edward M. |date=August 21, 1996 |title=Public Law 104-191. Health Insurance Portability and Accountability Act of 1996 (HIPAA) |location=Washington, D.C. |publisher=Government Printing Office |url=http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=104_cong_public_laws&docid=f:publ191.104.pdf |accessdate=February 22, 2010|display-authors=etal}} 9. ^1 {{cite journal |doi=10.1377/hlthaff.16.3.146 |author1=Atchkinson, Brian K. |author2=Fox, Daniel M. |date=May–June 1997 |title=The politics of the Health Insurance Portability and Accountability Act |journal=Health Affairs |volume=16 |issue=3 |pages=146–150 |url=http://content.healthaffairs.org/cgi/reprint/16/3/146.pdf |accessdate=February 22, 2010}} 10. ^1 {{cite journal |doi=10.1377/hlthaff.17.3.25 |author1=Nichols, Len M. |author2=Blumberg, Linda J. |date=May–June 1998 |title=A different kind of 'new federalism'? The Health Insurance Portability and Accountability Act of 1996 |journal=Health Affairs |volume=17 |issue=3 |pages=25–42 |url=http://content.healthaffairs.org/cgi/reprint/17/3/25.pdf |accessdate=February 22, 2010 |pmid=9637965}} 11. ^1 {{cite journal |doi=10.1377/hlthaff.19.4.7 |author1=Pollitz, Karen |author2=Tapay, Nicole |author3=Hadley, Elizabeth |author4=Specht, Jalena |date=July–August 2000 |title=Early experience with 'new federalism' in health insurance regulation |journal=Health Affairs |volume=19 |issue=4 |pages=7–22 |url=http://content.healthaffairs.org/cgi/reprint/19/4/7.pdf |accessdate=February 22, 2010 |pmid=10916957}} 12. ^1 {{cite journal |author1=Gabel, Jon R. |author2=Jensen, Gail A. |author3=Hawkins, Samantha |date=March–April 2009 |title=Self-insurance in times of growing and retreating managed care |journal=Health Affairs |volume=22 |issue=2 |pages=202–210 |url=http://content.healthaffairs.org/cgi/reprint/22/2/202.pdf |doi=10.1377/hlthaff.22.2.202 |accessdate=February 22, 2010 |pmid=12674423}} 13. ^1 {{cite web | date=March 22, 2010 |title= Side-by-side comparison of major health care reform proposals |location=Washington, DC |publisher=Kaiser Family Foundation |url= http://www.crawfordadvisors.com/whitePapers/Kaiser%20-%20Focus%20on%20Health%20Care%20Reform.pdf}} 14. ^1 {{cite journal |author=U.S. Department of Health and Human Services |date=June 28, 2010 |title=Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule |journal=Federal Register |volume=75 |issue=123 |pages=37187–37241 |url=http://edocket.access.gpo.gov/2010/2010-15278.htm |accessdate=July 26, 2010}} 15. ^1 {{cite web |author=Georgetown Health Policy Institute |date=January 2010 |title=Individual market portability rules (not applicable to HIPAA eligible individuals), January 2010 |location=Washington, D.C. |publisher=Kaiser Family Foundation |url=http://www.statehealthfacts.org/comparemaptable.jsp?ind=355&cat=7&sub=87&yr=138&typ=5 |accessdate=March 31, 2010}} 16. ^1 {{cite web |author=Georgetown Health Policy Institute |date=January 2010 |title=Non-group coverage rules for HIPAA eligible individuals, January 2010 |location=Washington, D.C. |publisher=Kaiser Family Foundation |url=http://www.statehealthfacts.org/comparemaptable.jsp?ind=356&cat=7&sub=87&yr=138&typ=5 |accessdate=March 31, 2010}} 17. ^1 {{cite web |author=Georgetown Health Policy Institute |date=January 2010 |title=Small group health insurance market pre-existing condition exclusion rules, January 2010 |location=Washington, D.C. |publisher=Kaiser Family Foundation |url=http://www.statehealthfacts.org/comparemaptable.jsp?ind=352&cat=7&sub=86&yr=138&typ=5 |accessdate=March 31, 2010}} 18. ^1 2 3 4 {{cite news|url=http://www.huffingtonpost.com/2009/09/14/when-getting-beaten-by-yo_n_286029.html|accessdate=September 19, 2009|publisher=The Huffington Post|title=When getting beaten by your husband is a pre-existing condition|first=Brian|last=Grim|date=September 14, 2009}} 19. ^1 2 {{cite news|url=https://www.washingtonpost.com/wp-dyn/content/article/2009/09/18/AR2009091803501.html|title=Acne, pregnancy among disqualifying conditions|date=September 19, 2009|accessdate=January 16, 2010|first=David S.|last=Hilzenrath|newspaper=The Washington Post |page=A3}} 20. ^1 {{cite web | year=2007 |url=http://allinsuranceinfo.org/health/tricks.html |title=Health insurance tricks to beware of|accessdate=January 20, 2010|publisher=allinsuranceinfo.org}} 21. ^1 {{cite web |author=Johnson, Rhonda M. |date=August 30, 2000 |title=Rural health response to domestic violence: policy and practice issues |url=http://ruralhealth.hrsa.gov/pub/domviol.htm |location=Washington, D.C. |publisher=Office of Rural Health Policy |accessdate=September 15, 2009}} 22. ^1 {{cite web|author=Tchijov, Maria |url=http://www.seiu.org/2009/09/domestic-violence-victims-have-a-pre-existing-condition.php|title=Domestic violence is a 'pre-existing condition'? |work=SEIU Blog |publisher=Service Employees International Union|accessdate=September 15, 2009|date=September 11, 2009}} 23. ^1 2 {{cite news|url=http://articles.sfgate.com/2009-11-17/news/17182067_1_health-care-health-insurance-pre-existing-medical-problem |newspaper=San Francisco Chronicle|date=November 17, 2009|accessdate=January 16, 2010|title=Americans fear health law's costs poll finds|author1=Ricardo Alonso-Zaldivar|author2=Trevor Tompson}}{{dead link|date=May 2017}} 24. ^1 {{cite news|url=http://articles.sfgate.com/2009-11-17/news/17182067_1_health-care-health-insurance-pre-existing-medical-problems|newspaper=San Francisco Chronicle |page=A118 |date=November 17, 2009|accessdate=January 16, 2010|title=Americans fear health law's costs poll finds|author=Alonso-Zaldivar, Ricardo |author2=Tompson, Trevor |agency=Associated Pres)}} 25. ^1 {{cite web|author=Suderman, Peter (opinion blog)|date=September 23, 2010|title=What the GOP's Pledge has in common with ObamaCare|work=Hit and Run|publisher=Reason|url=http://reason.com/blog/2010/09/23/what-the-gops-pledge-has-in-co|accessdate=September 23, 2010}} 26. ^1 {{cite web|title=Text of President Obama's health-care speech |url=https://www.marketwatch.com/story/full-text-of-president-obamas-health-care-speech-2010-03-03 |website= |accessdate=15 September 2018 |work= |date=3 March 2010}} 27. ^1 {{cite news| url=https://www.washingtonpost.com/wp-dyn/content/article/2010/09/22/AR2010092205365.html | work=The Washington Post | first1=N. C. | last1=Aizenman | first2=Anne E. | last2=Kornblut | title=Obama returns to stump for health care | date=September 23, 2010}} }} Further reading
4 : Health insurance in the United States|Insurance law|Health policy|Social problems in medicine |
| 随便看 |
|
开放百科全书收录14589846条英语、德语、日语等多语种百科知识，基本涵盖了大多数领域的百科知识，是一部内容自由、开放的电子版国际百科全书。