Health insurance - considered by many as a Constitutional right - becomes a little tricky for those with "pre-existing conditions." These are illnesses or medical problems that a person has prior to purchasing health coverage from an insurance company or enrolling through an employer's plan. Naturally, the insurer is reluctant to accept someone into their plan who is likely to need expensive treatment and medication. Yet, when those with pre-existing conditions change jobs, or those who become sick while on one plan are forced to look for another carrier, serious problems may arise.

Points of Controversy

There are several workable solutions to this problem, but none of them comes without financial setback to whoever is forced to pay the costs. The question is, who should that be? Should the person with the pre-existing condition be required to pay a higher premium than someone who is healthy, or excluded from purchasing insurance altogether? Should the insurance company be responsible for providing coverage to every person, regardless of health, and simply ignore the actuarial guidelines for price? Or, should the government subsidize the costs for everyone and ensure access and affordability for all its citizens? These are tough questions, with answers that are under discussion in neighborhoods, boardrooms, and statehouses across the country. A number of state legislatures have enacted laws that require private insurance companies to accept everyone who applies, regardless of condition. Some of these plans call for the insurance company to bear the burden of financial loss, while others make it such that those who can afford to pay are charged a higher premium. It is apparent that someone will carry the burden for those with pre-existing conditions who need health insurance; it is simply a matter of who that will be.

HIPPA of 1996

Title I of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 was the result of many discussions and state legislation enacted in the early 1990s. It guarantees that no person can be denied group health insurance through an employer because of a preexisting condition, nor can anyone be required to pay a higher premium than anyone else in the same employment category. HIPAA certainly goes a long way to address the problem of pre-existing conditions and health insurance granted through an employer, although it does not pertain to those who are self-employed or who need to purchase insurance through a private company for any number of reasons. HIPAA does extend its eligibility to individuals who change employers, as long as they do not let their coverage lapse for more than 63 days between jobs.

Know Your Rights

If you have a pre-existing medical condition and need to purchase health insurance, it is wise to check with your employer first. Familiarize yourself with your rights, and then talk with private insurers regarding the various options.