Report: Health reform could help 132,000 in N.D.

Health care reform legislation will mean about 132,000 North Dakotans under the age of 65 will no longer be at risk of being denied insurance coverage because of a pre-existing medical condition, according to a report released Thursday.

Families USA, a national organization for health care consumers based in Washington, D.C., commissioned a study to analyze how the reform passed in March would affect people across the country and in North Dakota.

During a conference call with reporters, Executive Director Ron Pollack said outlawing insurers from denying coverage based on an applicant’s pre-existing condition is one of the “key sets of provisions” in the legislation. That part of the reform will go into effect Jan. 1, 2014.

“This legislation can be very helpful to the people who are vulnerable today due to insurance company abuse of practices,” Pollack said.

Findings

The report looked at data on health conditions from the federal Medical Expenditures Panel Survey and demographic data from the U.S. Census Bureau.

Across the country, 57.2 million people were found to be at risk of getting denied by insurance companies because they have a diagnosed, pre-existing condition.

In North Dakota, about 132,000 people under the age of 65 — almost one-quarter of the state’s non-elderly population — have a diagnosed condition that could get them denied, the report said.

Pollack emphasized these numbers are only people who have been diagnosed with a medical condition that could be a basis for denial.

“We can only calculate based on federal data how many people have diagnosed pre-existing conditions,” he said, adding there are “a good number of people” who don’t have insurance, so the real number could be much higher.

“This 132,000 figure is a conservative number, albeit it’s the best number that we have,” Pollack said.

Those at-risk North Dakota residents come from all age groups, income levels and racial and ethnic groups. According to the report:

* 16.8 percent of those aged 18 to 24 have been diagnosed with a health condition that could be a cause for denial. That’s more than one in every six residents of this age.

* 46.9 percent of those aged 55 to 64 have a diagnosed pre-existing condition, the largest percentage among any non-elderly group.

* 26.2 percent of people in the lowest income group in the state have been diagnosed, making this income group the most likely to have a pre-existing condition.

* Almost three-quarters of state residents with pre-existing conditions, 73.1 percent, are middle class and higher-income Americans. “Income is no protection against an individual’s having a pre-existing condition that could lead to a denial of coverage,” the report said.

* 20 to 25 percent of whites, African Americans and American Indians in the state have pre-existing conditions. About 15 percent of Hispanics are affected.

Lessons

Pollack said there are a number of “takeaways” that can be learned from this report.

“Thousands of North Dakotans with diagnosed health conditions and the many others who at some point will receive such a diagnosis are the people with the greatest need for health insurance coverage,” he said.

Dustin Gawrylow, executive director of the North Dakota Taxpayers’ Association, questioned the meaning of the study because the big number it reports — 132,000 state residents have pre-existing medical conditions — doesn’t take into account that many of those people likely already have coverage through an employer or family member.

He also said prohibiting insurance providers from denying coverage based on pre-existing conditions doesn’t take into account what insurance is supposed to do.

“Insurance is not meant to be prepaid medical services,” he said.

Gawyrlow used an example to point out why he thinks this change doesn’t make sense for insurance policies.

“When your house burns down, you don’t go and call your insurance guy and say, ‘Hey, I need coverage yesterday,’” he said. “This really gets into the whole definition of what is insurance.”

Ryan Johnson is a reporter at the Grand Forks (N.D.) Herald,

which is owned by

Forum Communications Co.

Tags: health care, north dakota, news, national, reform