The Affordable Care Act (ACA) provides a range of nationwide protections for Americans with pre-existing health conditions. This analysis updates a 2011 analysis of the impact of the ACA’s pre-existing conditions protections. It confirms that a large fraction of non-elderly Americans have pre-existing health conditions and shows that tens of millions of Americans with pre-existing conditions experience spells of uninsurance. About 23 percent (31 million) experienced at least one month without insurance coverage in 2014, and nearly one-third (44 million) went uninsured for at least one month during the two-year period beginning in 2013. Many of these Americans could have been denied coverage, or offered coverage only at an exorbitant price, had they needed individual market health insurance before 2014.
This analysis also offers a first look at how health insurance coverage for people with pre-existing conditions actually changed when the ACA’s major insurance market reforms took effect in 2014. It finds that, between 2010 and 2014, the share of Americans with pre-existing conditions who went without health insurance all year fell by 22 percent, a drop of 3.6 million people. The ACA’s individual market reforms appear to have played a key role in these gains.
While data for Americans with pre-existing conditions are available only through 2014, it is likely that this group has shared in the continued gains in access to coverage and care over the past two years.