Legislation proposed by National Patient Advocate Foundation was introduced in the U.S. Senate and U.S. House of Representatives in March 2009.  Introduced by Senator John Rockefeller (D-WV) and Representative Joe Courtney (D-CT) the "Preexisting Condition Patient Protection Act of 2009" (S. 623/H.R. 1558), eliminates pre-existing condition exclusions and waiting periods for all individuals regardless of health status or insurance type.  

In addition, the "Children's Health Protection Act of 2009" (S. 642/H.R. 1619) was introduced in March 2009 by Senator Frank Lautenberg (D-NJ) and Representative Allyson Schwartz (D-PA).  This legislation eliminates pre-existing condition exclusions and waiting periods for all children and young adults under the age of 25.

NPAF continues to seek support in Congress for these important bills but we need your help! Contact your U.S. Representative and/or Senators and urge them to cosponsor S. 623 & H.R. 1558 and S. 643/H.R. 1619.  Visit www.senate.gov to learn learn how to contact your Senators or www.house.gov to learn how to contact your Representative.

Bill Information

S 623 / HR 1558 - Preexisting Condition Patient Protection Act of 2009

S 642 / HR 1619 - Children's Health Protection Act of 2009

Additional Resources

Health Insurance Portability and Accountability Act (HIPAA)
Achievements & Gaps
HIPAA Flow Chart

State High-Risk Pool
Primer
Debunking the Myths
Table

Brief of Patient Advocate Foundation as Amicus Curiae in Support of Petitioner - Supreme Court of the United States

NPAF Project on Pre-Existing Condition Restrictions

In 2007, National Patient Advocate Foundation began work on the issue of reforming utilization of pre-existing conditions to compress or eliminate access to care. The following is a brief discussion of the issue, how it impacts patients, and information on legislation proposed by National Patient Advocate Foundation.

Definition. A pre-existing condition, generally, is any physical or mental condition for which medical advice, diagnosis, care, or treatment was recommended or received or for which a prudent person would seek treatment. Typically, insurance plans define a pre-existing condition as occurring during a certain time period, such as six months, prior to enrollment. Laws defining pre-existing conditions vary from state to state. These pre-existing condition clauses result in a limitation or exclusion of benefits and coverage is denied.

Patient Impact of Pre-Existing Condition Language in Health Care Insurance. However a pre-existing condition is defined and regulated, if it results in a patient being refused coverage, this is a catastrophic event for that patient. That patient can now receive health care only by paying out-of-pocket, which is not possible for so many patients. In this way, the pre-existing clause results in a denial of access to health care.

NPAF Approach

NPAF recognizes that this is a long-term goal and anticipates working on this issue over the next few years. This complex issue, that is intrinsic to the commercial insurance industry, requires considerable research, analysis and strategy to identify, develop and advocate viable policy options and recommendations.

Quantification of the Problem. NPAF continues to gather data to identify the number of Americans affected by this provision as well as information concerning state laws and policies. Over the course of 2006 and 2007, NPAF will also work to identify and evaluate current proposals to revise the pre-existing condition system, reviewing studies, proposed and implemented local insurance programs and other models that have successfully resolved this issue.

Identification of Relevant Principles. NPAF will identify and analyze the components of this issue, including the following: HIPAA regulation of group health plans and the operation of "look-back, "look-ahead" and waiting period limitations.

Identification and Collaboration with Other Entities that Support Reform. NPAF will work to identify and collaborate with other allies on this issue. Other patient advocate organizations, particularly those that focus on specific chronic diseases, are likely to share these concerns.

Identify and Address the Concerns of Opposition to Reform. In moving forward on this project, NPAF will consider all viable approaches to alleviating and resolving the issue. We recognize that proposals to limit an insurer's ability to exclude coverage for certain pre-existing conditions will face considerable opposition. Insurers will be asked to assume greater risk in the increased likelihood that enrollees will require health care services in the future. This increased risk will likely result in increased premiums for all non-group policies. Accordingly, proposals identified for advancement will consider opposing arguments as well.

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