The Catch: The Uninsurables

News with clear eyes. (AP Photo/Khin Maung Win) News with clear eyes. (AP Photo/Khin Maung Win)

About 129 million non-elderly U.S. residents have health conditions that could make it difficult for them to buy health coverage in a state that allows medical underwriting, according to analysts at the office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services (HHS).

The analysts discuss pre-existing condition rates in a commentary supporting the Patient Protection and Affordable Care Act of 2010 (PPACA).

If PPACA takes effect as written and works as drafters expect, it will ban most types of medical underwriting starting in 2014. Carriers would still be able to charge higher rates for older insureds and insureds who smoke, and, in some cases, they might be able to use rate surcharges and discounts as wellness program incentives.

The ASPE analysts came up with two estimates of the size of the potentially uninsurable population.

One includes individuals who have such serious health problems, such as cancer or hemophilia, that they qualify for the new federal Pre-existing Condition Insurance Plan risk pool program.

The analysts also prepared a second estimate that includes people with conditions such as obesity, asthma and hypertension who may be able to get coverage but, in markets where individual insurers apply strict underwriting rules, may face the prospect of dealing with higher rates and pre-existing condition exclusions.

About 50 million U.S. residents, or 19% of non-elderly U.S. residents, have serious enough health problems to be uninsurable according to the PCIP standards, the analysts say.

When conditions such as obesity are included, about 50% could be considered uninsurable, the analysts say.

Today, the analysts say, many of those individuals do have health coverage, either because they are in government-run health plan programs or because they are in employer-sponsored group health plans and face no medical underwriting process.

About 82 million group plan members have pre-existing conditions that could make them uninsurable or difficult to insure if they applied for individual coverage and faced an individual underwriting process, the analysts report.

In the 55-to-64 age group, 48% to 86% of the individuals could be considered uninsurable or difficult to insure, the analysts estimate.


Joyce Martin and other researchers at the National Center for Health Statistics (NCHS)  have confirmed that the ratio of twin births to all births has increased rapidly in the United States since 1980.

In 2009, 1 of every 30 babies born in the United States was a twin, up from 1 in 53 babies born in the United States in 1980, the researchers report in a twin birth rate brief released by the federal Centers for Disease Control and Prevention (CDC).

From 1915 to 1980, the ratio held steady at about 1 twin to 30 singletons.

The vast majority of the twins were healthy, but women who are carrying twins are more likely to develop a form of high blood pressure that can lead to strokes, they are more likely to need bed rest, and they are more likely to give birth prematurely. Pregnancies involving triplets, quadruplets and other "super twins" are even more likely to lead to serious complications.

Older women tend to have more twins than younger women, even when no fertility treatments are involved, but the NCHS researchers say the increase in maternal ages in recent years appears to explain only about one-third of the increase in the twin birth rate.

The states that require state-regulated insurers to cover at least one round of in vitro fertilization for couples with fertility problems are Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey and Rhode Island, according J. Ryan Martin and other researchers at the Yale University medical school.

The states with the biggest increases in twin birth rates between 1980 and 2009 are Connecticut, Hawaii, Massachusetts, New Jersey and Rhode Island, according to the NCHS researchers.


Life, health and property-casualty insurers sent 11% less direct mail to U.S. consumers during the third quarter of 2011 than during the comparable period in 2010, according to direct mail analysts at Mintel Comperemedia, Chicago.

Direct mail volume fell 17% for life insurers, 8% for p-c insurers, and 7% for health insurers, the analysts estimate.

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