Health insurers oppose elimination of pre-existing condition clauses.

FACT: BCBSNC and many other insurers strongly support the elimination of pre-existing conditions clauses and health-based underwriting, as long as everyone is coveredby medical insurance. Insurers have traditionally included such clauses in insurance contracts to encourage people to be continuously covered with health insurance, whether they are sick or ill. Pre-existing condition clauses and health based underwriting are simply tools to encourage people to stay covered and to maintain a broad-based pool which improves affordability for all.

If the personal responsibility requirement with sufficient enforcement goes through, it will be time to retire these types of tools. Here’s why they can be beneficial:

• If someone has a heart condition that existed at the time of enrollment, they can still buy comprehensive medical insurance that will cover other needs unrelated to that condition.  For example, treatment related to a new cancer diagnosis or emergency services would be covered – even during a temporary waiting period for the heart condition.  Pre-existing condition clauses help make coverage more affordable.
• Pre-existing condition clauses create a strong incentive to carry coverage all the time – not just when you’re sick. This keeps a lot of healthy individuals in the medical insurance pool, keeping costs down for everyone.

We want to see a health care system in which no one would be denied coverage or face unaffordable rates because of their health circumstances. We would prefer to eliminate this kind of underwriting entirely, but that can only be done if we can get everyone – sick, well and in-between – paying into the health insurance system on a consistent basis, creating a broad-based pool to spread out and absorb these costs.