Michael Castellarin, MD
In March of 2010, the Affordable Care Act (ACA) became the most significant change to the US healthcare system in almost half a century. This January, health care reform again entered the national conversation as discussions to repeal and replace the ACA ensue. One of the most influential provisions of the ACA was the pre-existing conditions clause which led to a ban on medical underwriting, thus providing health insurance coverage for a multitude of people previously ineligible unless covered by an employer.
As a family medicine intern training at an urban federally qualified health center (FQHC), I care for the medically underserved; a population defined by their complex health care needs and lack of financial resources which, prior to the ACA, left this group particularly vulnerable to medical underwriting. As health care policy shifts once again, the importance of pre-existing condition coverage must be realized and must be protected, particularly for those less fortunate.
Prior to the passage of the ACA, the practice of medical underwriting was commonplace in the individual health insurance market. Common ailments such as diabetes, heart disease, and obesity left patients uninsurable. Those insured through an employer avoided underwriting but oftentimes those in medically underserved populations were forced to shop for health insurance on the individual market because of unemployment or low wage employment without employer-sponsored insurance.
STFM Blog 