A Lesson on Pre-existing Conditions

10/04/2012 05:32:00 PM
I worked in a children's hospital for a few years, focusing on research on sickle cell disease. The disease is genetic: sickle cell is a recessive trait that, when a child inherits the trait from just one parent offers protection against malaria--an evolutionary advantage--but unfortunately when a child inherits the trait from both parents causes sickle cell disease, which is associated with pain, inflamation, blood clots, even strokes. With treatment, children with sickle cell disease can live long fulfilling lives, though not entirely free from complications. Without treatment, the children will be unlikely to survive into adulthood.

Way back in the day, the diagnosis for sickle cell disease depended mainly on observing the symptoms, meaning that diagnoses generally could not be made until the child was at least four months old. By that time, for parents with family insurance plans, the child could be enrolled on health insurance and be guaranteed coverage for treatment of sickle cell. These days, however, infants are screened immediately at birth--the earlier we make the diagnosis and begin treatment, the better and longer the child's life will be.

But there is just one problem: children aren't always born during insurance company's open-enrollment periods. This means that the parents have to wait until the open enrollment period until they can add their new born infant to their health plan, by which time the diagnosis for sickle cell disease will have already been made. And that means that--prior to Obamacare--insurance companies were within their legal rights to deny coverage of any sickle cell treatments because the child's disease was a "pre-existing condition"--even though that condition is genetic!

This is (or I should say was) a real world situation often encountered at the hospital's hematology division. What is notable about the example is that the parents did everything right--they had continuous coverage on a family insurance plan, yet were still denied coverage for their child's life-shortening condition. Under Mitt Romney's plan, children with sickle cell disease born outside of their insurance plan's "open enrollment" periods will still be denied coverage. Under Obamacare, that is a thing of the past.