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Underinsured Utahns

A gap in insurance coverage meant Kim couldn't get the eye surgery she needs because it is a pre-existing condition...
Gap in insurance leads to pre-existing conditions

In 2006, Kim was diagnosed with cervical cancer. Treatment prevented her from working, and her employer was not willing to grant her any flexibility. Eventually she lost her job and along with it her health insurance. To cover all of her medical bills she finally gave up her house and what few other assets she had. Fortunately, Kim conquered her cancer. She also found a new job with health insurance.

However, her gap in coverage continues to haunt her. Due to the cancer treatment, Kim has developed retinal detachments, first in her right eye and now in her left one. At first she could only see in well-lit condition; then, she had trouble recognizing faces and struggled to read; and finally night blindness. Her vision got so bad she faced losing her job again!

Kim needed surgery to re-attach her retina, and though she now had insurance, her retinal detachment was deemed a pre-existing condition. Kim felt blocked at every turn. As her eyesight continued to worsen, she was finally referred to a local hospital’s financial assistance program. “They saved my life,” says Kim. The hospital paid for the exams and surgery in her right eye. Now, she needs surgery in her left eye.

Once again Kim has nowhere to turn—will her insurance be there when she needs it, or will she have to rely on the hospital’s kindness again? Or will she lose her eyesight?

The Patient Protection and Affordable Care Act was designed to protect people like Kim

The Patient Protection and Affordable Care Act (PPACA) essentially guarantees that those with pre-existing conditions will have the ability to purchase insurance coverage. Within 90 days of enactment, Americans who have pre-existing conditions and have not been covered by insurance for at least six-months may sign up for a new high-risk insurance pool. This high-risk pool will continue until 2014, at which time all insurance carriers will be prohibited from excluding an individual based on a pre-existing condition.

In addition, the new health care reform law eliminates lifetime caps on essential benefits provided under group health plans. This prohibition on lifetime caps is effective six months after enactment of the bill (September 23, 2010). Additionally, the PPACA places restrictions on annual limits that may be imposed upon plan participants.