Saturday 01 Nov 2014

Information and opinions presented here do not always represent the views of the American Heart Association.

Health insurance can’t be denied for pre-existing conditions under the Affordable Care Act

Published: 10:34 am CDT, February 25, 2014

Stroke survivor Ron Byzet with his sons Alex (left) and Andy and his daughter-in-law Brooke less than two months after his stroke in February 2013. Photo by Stephanie Mohl

When Ron Byzet was laid off as a government contractor for NASA after 33 years on the job, he also lost his health insurance. He wasn’t old enough for Medicare, but he knew he would qualify in a few years and thought he would make it.

Then, in February 2013, Byzet had a stroke.

Next came the medical bills, said the 63-year-old resident of Huntingtown, Md.

He had a $9,000 bill from his two-day hospital stay and a monthly tab of $1,000 for diabetes and heart medications. He also paid out of pocket on every visit to his primary care physician and endocrinologist.

After more than a year without insurance and with his savings depleted, Byzet was able to buy coverage under the Affordable Care Act, despite his pre-existing conditions.

With the new governmental insurance program, health insurance companies can no longer deny health coverage to people or charge higher premiums because of a pre-existing condition, such as high blood pressure or a congenital heart defect.

Plans sold through the federal and state-based marketplaces, or exchanges, cover doctor visits, hospitalization, rehabilitative care, prescription drugs and other services without any restrictions as of Jan. 1.

It’s unclear how many uninsured heart disease and stroke survivors like Byzet signed up for coverage. But statistics show millions needed it: About 7.3 million Americans with a history of cardiovascular disease were uninsured prior to the law’s enactment, according to data from the Centers for Disease Control and Prevention’s National Health Interview Survey.

So far, nearly 3.3 million people overall have enrolled since the online health insurance marketplaces launched last October, federal officials said in early February. Another 3.2 million Americans were found eligible for Medicaid or the Children’s Health Insurance Program through the marketplaces, although officials do not know how many of these people were renewing or would have qualified for Medicaid before the new law expanded eligibility.

The new pre-existing conditions protections allow people with a history of cardiovascular diseases to have access to timely treatment and preventive care, said Elliott Antman, M.D., a cardiologist at the Brigham and Women’s Hospital and professor of medicine at Harvard Medical School.

Research has found being uninsured means people are less aware – and less in control – of their cardiovascular risks, putting them at higher risk for a stroke and dying from that stroke.

“Even if individuals knew what they should be doing to deal with their existing cardiovascular condition, they had trouble implementing it because they couldn’t afford the preventive services or the medications,” said Antman, president-elect of the American Heart Association.

Nearly half of uninsured Americans with cardiovascular disease said they simply could not afford it, the CDC survey found. Cost was the barrier for Byzet, who was told COBRA – an insurance option that allows laid-off workers to temporarily keep their job-based health coverage – would cost him $1,200 a month. Under the Affordable Care Act, he qualified for a tax credit subsidy and now pays a monthly premium of $350.

The American Heart Association has set an aggressive goal to improve heart health and to reduce heart disease and stroke deaths by 20 percent by 2020. Eliminating pre-existing conditions exclusions will help the nation get there, Antman said.

Back in Maryland, Byzet isn’t wasting any time taking advantage of his new coverage. Appointments with his primary care doctor and endocrinologist are already on his calendar. “You can’t do anything about a pre-existing condition. You’re pretty much stuck,” he said. “But I’m not as worried as I was, because now I have something that’ll take care of me.”

People have until March 31 to sign up for coverage and avoid paying a fine through their taxes.

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