Pre-Existing Conditions: The Age Group Most Vulnerable If Coverage Goes Away


Published:

© rawpixel on Unsplash

A widely shared New Yorker cartoon heralded “70 as the new 50” with the implications that being 50 was a joyous and healthy age. More than 10 years later, we are seeing that being in one’s 50s may have its drawbacks, at least in terms of current American political debates around repealing key provisions of the Affordable Care Act.

Coverage for pre-existing conditions, which has reduced the uninsured rate by an estimated 22 percent, has been a cornerstone of the ACA. It is generally viewed as the most popular element of ACA by proponents and opponents alike.

But now, that coverage is imperiled by proposed challenges to mandated health insurance coverage. The Justice Department in June supported lawsuits filed by attorneys generals in 20 states that claim that coverage for pre-existing conditions was eliminated when the administration’s tax bill was passed in December 2017. In that bill, Congress repealed the penalty, starting in 2019, for people who do not have health coverage.

While the jury is still out on the ultimate fate of the ACA, dismantling preexisting coverage would be particularly troubling for those in their 50s and early 60s who have not yet reached 65, the age at which most people become eligible for Medicare.

As a researcher focused on public health and aging issues, I think it’s important that health care needs for our aging population be viewed within a broader family and societal context. Additionally, it’s important to recognize that aging is a lifelong process. Health and well-being in the later years are largely determined by what are known as the social determinants of health, or factors within a society that influence a person’s health. These factors include such things as race, ethnicity, education, income, employment and even neighborhood environments.

I research these social determinants and how they affect people’s access to health care and their health. I see several issues at the intersection of aging, health, and health care policy and research that can inform this debate.

Far-Reaching Consequences

According to a recent Kaiser Family Foundation report, it is likely that more than a quarter of American adults under age 65 have pre-existing health conditions that would make them uninsurable for individual market coverage under pre-ACA underwriting practices. But it is the near-elderly, or those those 55 to 64 and who number more than 40 million, who would be most affected.

Upwards of 80 percent of persons in the 55 to 64 age group have conditions such as high blood pressure, high cholesterol, heart conditions, asthma/chronic lung disease, diabetes, cancer or behavioral health disorders that would affect their qualification for insurance. This generation, also referred to as “Generation Jones,” are one generation behind those already eligible for Medicare and hence less affected by such policy changes. Those in Generation Jones because of their health and employment status are likely to be most impacted if mandates against pre-existing exclusions are overturned.

Chronic Diseases Increase With Age

Most chronic conditions are aging-related, meaning they are more prevalent in the later years of life. However, chronic disease rates start accelerating in mid-life. About 50 percent of people between 45 and 64 have multiple chronic conditions, compared to 18 percent among those 18-44 years of age. The early onset and progression of unchecked obesity-related common chronic conditions, such as heart disease, diabetes and cancer, are linked to increased governmental health care costs once eligible for Medicare.

Without access to health care, the near-elderly are less likely to take advantage of proven clinical preventive services, such as mammograms, influenza vaccines or counseling to increase physical activity and referrals to community exercise programs, that can help detect many chronic conditions, delay their onset or reduce disease progression and further complications.

The negative consequences of health care coverage policy changes, while concentrated among the near-elderly, will not be universal. Public health experts note that effects will be more pronounced among those with lower incomes or racial and ethnic minorities. These groups are likely to find it most difficult to obtain affordable insurance if pre-existing conditions were grounds for denying coverage.

Why The Joneses Are So Vulnerable

On the surface, Generation Jones may look like a more stable group relative to younger groups in terms of workforce participation and insurability. However, many in Generation Jones have less access to coverage than the first wave of boomers who have already crossed into the Medicare safety net.

Concerns about job security have always been a hallmark for Generation Jones. Low-income Joneses are especially vulnerable being in jobs without adequate health care coverage. Or, even if currently covered by employee health insurance, Joneses are at risk of losing coverage if they lose their jobs or decide to retire before 65. Despite recent upticks in the economy, people 55 and older if unemployed still find it harder to find comparable jobs

Rescinding or denying health care coverage for pre-existing conditions impacts Joneses and their family members too. An estimated 50 percent of Americans live in households where a family member would be denied coverage for pre-existing conditions. Concerns about health care coverage are impacting critical life choices for families. Even those who are Medicare age are reluctant to retire because they want to keep employee-sponsored health care coverage for their younger spouses who have pre-existing conditions.

Solutions For The Near-Elderly

Many think tank institutes and aging advocacy groups, such as AARP, are calling attention to the probable plight of the near-elderly if protections for pre-existing conditions are eliminated in future health care insurance policy mandates – reiterating many arguments heard in the early 2000s.

I believe it is critically important to keep these issues in the forefront, especially as policies are being debated. Generation Jones may not be as visible as their older baby boomer siblings, but they have the potential to be active players in this debate, as they have already demonstrated in prior elections.

Our society can not overlook untoward consequences for those in the 55-64 age group who become uninsurable. Moreover, I do not think the bigger policy questions can be ignored. For example, will saving money today result in short-term savings that only push the costs of care to another funding stream when Generation Jones become eligible for Medicare?

It is hard to imagine protection for pre-existing coverage for those 55-64 being overturned given the universal appeal of this mandate and the policy reports already being generated. The current health care coverage debate is part of a larger public health discussion about the health and productivity of future generations of Americans. The last wave of the baby boomers – Generation Jones – will not turn 65 and reach Medicare eligibility for another 10 years. Thus, I believe an enduring solution is needed now to address this long-term problem for the current group of near-elderly.

Marcia G. Ory, Ph.D., M.P.H., is Regents and Distinguished Professor, Department of Environmental and Occupational Health, School of Public Health (SPH) at The Texas A&M University Health Science Center in College Station, Texas. Her primary administrative roles are serving as Associate Vice President for Strategic Partnerships and Initiatives and chairing the Opioid Task Force.

This article was originally published on The Conversation.

See also:
Unconventional Medicine — The Revolution To Reinvent Health Care And Reverse Chronic Disease
National Improved Medicare For All Making Progress

The Conversation

Edit Module
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags

Daily Astrology

August 17, 2018

The waxing Scorpio Moon makes a nifty series of supportive aspects. The early morning is especially inspiring. A lunar conjunction with Jupiter fosters self-assurance, optimism and faith in others. Both stars are in a favorable trine to mystical Neptune…
Edit ModuleShow Tags

Alternative Health Directory

Browse all listings »

Edit ModuleShow Tags
Edit ModuleShow Tags

Calendar

August 2018

A fantastic shopping and educational experience for the whole family! Vendors come from New England, across the US, and many foreign countries to exhibit minerals, fossils, gemstones, jewelry,...

Cost: $8 adults, under 13 free

Where:
Eastern States Exposition
1305 Memorial Ave.
West Springfield, MA  01089
View map »


Sponsor: LLD Productions, Inc.
Telephone: 505-867-0425
Contact Name: Regina Aumente
Website »

More information

Readings, healings, vendors, presentations.

Cost: Free

Where:
Hilton Garden Inn
85 Glastonbury Blvd.
South Glastonbury, CT  06066
View map »


Website »

More information

During the weekend of August 10-12, 2018 we will gather again at Hampshire College in Amherst, Massachusetts for the 44th Annual NOFA SC. This immersive annual gathering is an opportunity to come...

Cost: See website

Where:
Hampshire College
Amherst, MA


Sponsor: Northeast Organic Farming Association
Telephone: 774-262-7986
Contact Name: Marjorie Bailey
Website »

More information

Show More...
Show Less...

August 13 - 17, 9am - 1pm Instructor: Peyton Pugmire For student entering grades 6-8 iPhones are amazing, but you know what’s even more amazing? You! During this imaginative week...

Cost: $250

Where:
Creative Spirit
80 Washington Street
Marblehead, MA  01945
View map »


Sponsor: Creative Spirit
Telephone: 781-797-0389
Website »

More information

August 13 - 16 Juan Li has been teaching Daoist energy practices for the last 27 years. He has created a sequence of practices based on the I Ching, adapted to the emotional and mental...

Cost: $950 single retreat; $1650 for both retreats (8/16)

Where:
Angels’ Rest Retreat
63 North County Road
Leyden, MA  01337
View map »


Sponsor: Tao Retreats
Telephone: 212-243-6771
Contact Name: Sharon Smith
Website »

More information

August 13 - 14 This fun and exciting healing workshop guarantees you valuable knowledge and powerful skills to keep you in a higher vibration of energy and flowing with infinite intelligence and...

Where:
Royal Plaza Best Western
Marlborough, MA


Sponsor: Geozuwa
Telephone: 646-606-9935
Website »

More information

August 13 - 21 With NLP training and master healer certification. This course is specifically designed for healers of every modality. For information call (646) 606-9935 or visit...

Where:
Marlboro, MA


Telephone: 646-606-9935
Website »

More information

Show More...
Show Less...

August 14 - 24 For millennia people have entered the wilderness to encounter Spirit and seek their direction, purpose, or medicine. If you are seeking guidance and renewal, or you’re...

Cost: $1295

Where:
Somerset Lake
P.O. Box 48
Putney, VT  05346
View map »


Sponsor: Circles of Air and Stone
Telephone: 802-387-6624
Contact Name: Sparrow Hart
Website »

More information

What better way to end a busy day than with a little bliss. We'll support your body right where it is today and help you to open your spine to find more movement and flexibility. Begin and end...

Cost: $18

Where:
Body Love Wellness Center
484 Bedford St
East Bridgewater, MA  02333
View map »


Sponsor: Bliss Through Yoga
Telephone: 508-331-3564
Contact Name: Janice
Website »

More information

Show More...
Show Less...

Yoga is an ancient behavioral practice that allows for the development and enhancement of mind-body skills and behavioral factors including physical functioning, self-regulation of internal...

Cost: Free

Where:
CIC Cambridge
One Broadway
Charles Conference Room, 14th Floor
Cambridge, MA  02142
View map »


Sponsor: CIC Wellness
Telephone: 617-953-0674
Contact Name: Shakti Rowan
Website »

More information

Barbara Macias will present an information workshop on the benefits of essential oils. A demonstration of the oils will be included. Please RSVP at katboston@comcast.net

Cost: Free

Where:
NBA Business Center
145 Washington Street
Route 53
Norwell, MA  02061
View map »


Sponsor: Mind Balance Hypnosis
Telephone: 339-788-1193
Contact Name: Kathryn Caruso

More information

Relax and restore this summer with free outdoor yoga classes on historic Rogers Field! We’re packing the lawn with yogis of all levels for yoga led by experienced practitioners from Dragonfly...

Cost: Free

Where:
Rogers Field
Devens, MA


Sponsor: Dragonfly Wellness Center
Telephone: 978-487-7181
Contact Name: Anne Ferguson
Website »

More information

Show More...
Show Less...

August 16 - 19 Magnetic-harmonic vibrational therapist, Jay Emmanuel, A.K., N.S.,V.M. shares powerful energy techniques that use the forces of sounds produced by the human voice in combination...

Cost: Please see our website

Where:
Eastover Estate & Retreat Center
430 East St.
Lenox, MA  01240
View map »


Telephone: 866-264-5139
Contact Name: Yingxing Wang
Website »

More information

August 16 - 19 Juan Li has been teaching Daoist energy practices for the last 27 years. He has created a sequence of practices based on the I Ching, adapted to the emotional and mental...

Cost: $950 single retreat; $1650 for both retreats (8/13)

Where:
Angels’ Rest Retreat
63 North County Road
Leyden, MA  01337
View map »


Sponsor: Tao Retreats
Telephone: 212-243-6771
Contact Name: Sharon Smith
Website »

More information

Daily practice for peace, healing, Christ mindedness, meditation, awakening.

Where:
Milton, MA


Telephone: 617-696-5685
Website »

More information

Show More...
Show Less...

With June Edward, “The Massachusette Medium” This is a mediumship gallery with June Edward, the “Massachusetts Medium!” Have you ever wanted to talk to someone on the...

Cost: $55 on Eventbrite, $60 at door

Where:
Plymouth Lodge AF & AM
116 S Meadow Rd
Plymouth, MA  02360
View map »


Sponsor: June Edward “The Massachusetts Medium”
Telephone: 508-259-1231
Contact Name: June Edward
Website »

More information

Show More...
Show Less...

Guide: Peyton Pugmire Ages 16+ Like meditating with a paintbrush! Escape your stress and routine and re-connect with yourself, your heart and soul - one brushstroke at a time. This fun...

Cost: $85 (includes cost of all supplies)

Where:
Creative Spirit
80 Washington Street
Marblehead, MA  01945
View map »


Telephone: 781-797-0389
Contact Name: Peyton Pugmire
Website »

More information

Show More...
Show Less...
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags