Under Trumpcare, Having a High Fever Once Is a Pre-Existing Condition

There are horror stories of all kinds of crazy things being deemed “pre-existing conditions” before the Affordable Care Act.

|
May 25 2017, 2:49pm

Keith with her family. Image: Courtesy of Tanya Keith

When Tanya Keith's husband was laid off in the fall of 2008, their family lost their health insurance. But she didn't panic. Her middle class family was healthy, nobody had any chronic conditions. She figured getting her family insured wouldn't be a problem.

Then she learned that a high fever her toddler son had, once, a few months before, was considered a "pre-existing condition." His premiums skyrocketed, and he wouldn't be covered for any respiratory-related care for four years.

Then it was time to panic.

"It was terrifying," Keith told me. "A one and a half year old? Every single claim will be respiratory, aside from checkups and the occasional stomach flu, and [the plan] was hugely expensive."

Keith's story took place prior to the Affordable Care Act, which prohibits insurers from denying, charging more, or limiting coverage due to a pre-existing condition. The House passed the American Health Care Act last month, which the Congressional Budget Office finished analyzing Wednesday and found 14 million more people would be uninsured next year if the law passes.

If the legislation passes through the Senate, it will once again allow insurers to limit or deny coverage based on pre-existing conditions, Keith said it's important for people to realize that, without the ACA, anyone could be vulnerable to the devastating pitfalls of the former system.

"The system isn't there to help people get insurance. It's there to help insurance companies make a profit."

Keith, a historic preservationist and mother of three in Iowa, told me that she is a "lifelong liberal," but that before this all happened, she had a lot of faith in America's healthcare system.

"For a young, gainfully-employed couple, I didn't really see anything wrong with the system," Keith said. "When this all went down, it was a huge rude awakening for us."

At the time, Keith ran her own business while her husband worked for a small startup. Her husband was laid off when the startup went under, and they found out their insurance had actually been void for months.

Before the ACA, if you were uninsured for 60 days or longer, insurance companies could charge steeper fees, and limit or deny coverage based on pre-existing conditions. But since no one in her family was sick, Keith said she still wasn't very concerned.

Read more: Trump's Latest Health Pick Thinks IUDs Kill Babies

When she approached Wellmark, the leading individual health insurer in Iowa and South Dakota, Keith was stunned to see her son denied respiratory coverage. In fact, she thought it was a mistake.

A few months earlier, just before his first birthday, her son had a high fever, spiking to 106.1 degrees Fahrenheit. To be safe, Keith and her husband took their son to the emergency room, where he was given antibiotics using a nebulizer (a device that delivers medication via a mist, and is sometimes necessary for chronic conditions). The baby wasn't kept overnight, but was sent home with the nebulizer, which Keith said they were instructed to use that evening. By the next day, and after a visit with their pediatrician, he was given the all clear: just an infection, that had since passed.

But even after having her pediatrician write a letter to Wellmark explaining that her son had no chronic condition, did not use a nebulizer, and had no health issues from the visit, their full coverage was still denied.

I reached out to Wellmark for confirmation, and while the spokesperson told me she couldn't comment on specific cases, she did verify that this kind of situation used to happen.

"I can confirm that before the Affordable Care Act was in place in 2014, it was common for health insurance carriers to evaluate the health status, health history, and other risk factors of applicants from the previous year to determine whether, and under what terms, to issue coverage," Traci McBee, a spokesperson for Wellmark, wrote in an email.

"The ACA introduced guaranteed issue to the individual market which means that everyone can now purchase health insurance regardless of their health status and have access to care —as the future of the ACA is being decided, Wellmark believes this piece of the ACA should remain."

Eventually, Keith was able to get her children coverage under the Children's Health Insurance Program, but only because their family was in a tight financial situation. After her husband's company went under, his final two paychecks bounced, putting them in the red. The silver lining was this qualified the family for the state insurance.

These days the family has insurance through their current employers. But she told me it opened her eyes to how quickly the system could let people slip through the cracks, even if they're healthy.

"I was really naive before this experience," Keith said. "I realized the system isn't there to help people get insurance. It's there to help insurance companies make a profit, and it was awful."

Subscribe to Science Solved It , Motherboard's new show about the greatest mysteries that were solved by science.