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Coronavirus FAQ: Could COVID-19 Ever Be Considered A Preexisting Condition?

Photo caption:

Photo by Mark Ralston AFP via Getty Images

A nurse checks vitals for a Navajo woman, who came to a COVID-19 testing center in Arizona, complaining of virus symptoms.

Health insurers used to be able to deny coverage – or charge more – for an applicant who had a preexisting medical condition. That's the industry term for a condition that could range from allergies to cancer.

The Affordable Care Act changed all that as of 2014, guaranteeing coverage for those with preexisting conditions. But now the Supreme Court is hearing oral arguments, starting Tuesday, on a case filed to overturn the Affordable Care Act.

And people are wondering: If preexisting conditions were again to become a cause to deny coverage, would a COVID-19 survivor be in jeopardy?

Before we discuss this question, it's important to note that you shouldn't worry ... yet. It's unlikely the court will rule on the case before next spring.

And even if the Supreme Court were to overturn the law, existing coverage contracts would likely stay in place for at least a couple of months, said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, in a briefing Monday with reporters.

Now on to the FAQ about COVID-19.

In pre-ACA days, a bout with a virus might not have been considered a preexisting condition. That's because many people tend to recover quickly from viruses.

But in a blog post last week, researchers at the Rand Corp. suggested that COVID-19 could be seen differently by insurers. "Given the chronic problems [which can include organ damage, fatigue and confusion] associated with some COVID-19 cases, it is possible that some insurers would place restrictions on anyone who had a confirmed case of COVID-19," wrote Carter C. Price, Rand's senior mathematician, and Raffaele Vardavas, a mathematician at Rand who specializes in infectious disease models.

The researchers said that exclusion might also extend to people who didn't have a positive coronavirus test but did test positive for antibodies to the virus, which indicates they had it or were previously exposed.

"While a mild case of COVID-19 might not be subject to a preexisting clause, that would be up to insurers to determine," said Karen Pollitz, senior fellow, health reform and private insurance at the Kaiser Family Foundation.

Pollitz added that insurers could also impose a preexisting exclusion for COVID-19 for anyone at higher risk of getting the virus — such as grocery store clerks or ride-share drivers who are exposed to the public and who test frequently to determine if they have COVID-19.

"Just a history of frequent testing could be something insurers could act on," Pollitz said.

And that's not all. Someone who developed anxiety and/or depression since the start of the pandemic might also be considered to have a preexisting condition. Twenty years ago, Kaiser surveyed health insurance underwriters and asked about a similar situation: a hypothetical applicant in perfect health except for "situational depression" following the death of a spouse. According to the survey, "in 60 applications for coverage, this applicant was denied a quarter of the time, and offered coverage with a surcharged premium and/or benefit exclusions 60% of the time."

So both experts and consumers are concerned that invalidating the Affordable Care Act could mean that once again, individuals with preexisting conditions might not be covered — and such conditions could include COVID-19.

Then again, protection for those with preexisting conditions is a popular feature for consumers — and, by extension, their elected officials. If the ACA is overturned, it's expected that President-elect Joe Biden would work on new ways to offer coverage for people with preexisting conditions.

Fran Kritz is a health policy reporter based in Washington, D.C., who has contributed to The Washington Post and Kaiser Health News. Find her on Twitter: @fkritz

Copyright 2020 NPR. To see more, visit https://www.npr.org.

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