Pre-Existing Conditions, Part 2

see Part 1

There was a time, 30+ years ago, when a “pre-existing condition” clause in a health insurance policy did not seem unreasonable to me.

I’m working from memory here, looking back to my twenties, when I was just out of school and starting to make my own way in the world. I had a few jobs that offered group insurance, and I recall shopping for an individual policy when they didn’t. At that time, premiums weren’t altogether out of reach for a healthy person with a paycheck.

I’m sure I read at least one plan that excluded coverage for pre-existing conditions. Fair enough, I thought. For the likes of me, that might mean I broke my leg or caught strep throat the week before the policy was in effect. Of course the insurance company wouldn’t pay to treat an illness that didn’t happen on their watch!

Back then, I viewed illness and injury as temporary things. If they didn’t kill you, they could be cured, and then you could get on with your life. I had no concept of injuries that result in long-term disability; of chronic diseases like diabetes that require lifetime management and care.


I can’t prove it, but as I recall, the exclusions on my insurance policy were temporary, too. If you did happen to have diabetes, it would be covered after six months or so. If my broken leg mended, and I fell off a ladder two years later and broke my arm, it would be treated as a new injury. My emergency-room bill would be paid.

Nowadays, the diabetic would face a lifetime exclusion on treatment of her chronic disease — or more likely, wouldn’t be able to buy health insurance at all. And there’s a good chance my policy would exclude treatment for all broken bones, on the grounds that I’d broken one before.

You think I’m kidding? Let me share some real stories.

Sometime in the 1980s, my brother took a job in a new town. He and his wife were around 30 at the time, maybe not even that old. Health insurance was available through a trade association. He did the paperwork, which included a medical history for each member of his family. A few weeks later, he received a policy and acceptance letter, thank you very much. Except...

On her medical questionnaire, his wife admitted to having two migraine headaches in her life. The insurance company was willing to include her in the family policy — but due to this history of migraines, they were excluding her brain, heart, and circulatory system.

“You’re excluding her whole body!” my brother railed, when he called to argue with them. I think he wound up refusing the policy. I don’t recall what they did after that.

In the ’90s, I belonged to a freelance communicators’ networking group. Most of us were women in our 30s and 40s. We kept a directory of services offered by group members, helped one another with referrals, and met once a month to share business tips. At one session, I led a seminar on health care options for self-employed people.

It was a big issue for me. I was working a half-time job and freelancing on the side. My freelance work was starting to bring in a fair amount of money, enough to make me think about taking the plunge and making it a full-time business. But my spouse was already running his own small business, and my half-time gig provided health insurance for both of us. Would we be able to replace that? I decided to find out what I could and get a group discussion going.

Boy, did I hear some stories.

We learned that some providers considered writers to be bad risks, because we’re statistically more likely to have drinking problems and depression.

The stigma seemed to be less if you billed yourself as a graphic artist or a P.R. consultant. But still, there were those pre-existing conditions.

One woman, I’ll call her “Ann,” had suffered a whiplash injury a few years back. She found somebody who would sell her a health insurance policy, but they wanted to exclude her neck. After quite a bit of back-and-forth communication, she managed to talk them around. “Don’t give up too easily. Sometimes you can negotiate,” she told us.

“Beth” was offered a policy that covered everything but her breasts. At some point, she had found a couple of suspicious lumps and had them checked out. Isn’t that what the posters, pamphlets, magazine ads and TV PSA's keep reminding us to do? Neither of Beth’s lumps turned out to be cancer. But her insurance company wanted nothing to do with those boobs.

Then there was “Claire,” who taught elementary school for a number of years, but left that career to devote more time to writing. She was getting enough work to pay the rent and groceries, but finding health insurance was a challenge. She was, after all, a writer (see above), and besides that, Claire is a polio survivor. She walks without crutches, but has an obvious limp. Finally, her independent agent found a company that would insure her — but there would be no coverage for that gimpy left leg.

“Let me get this straight,” the agent said. “Suppose she’s waiting at a bus stop, and there’s a drive-by. If they shoot her in the right leg, you’ll pay for her to go to the emergency room and get it patched up. But they shoot her in the left leg, she’s SOL?” That’s right, said the insurance company. And I dare say they said it with a straight face.

Nobody really knows how well this new health care law will work. As I’ve said before, I’m sure it will need some tweaking as we go along. But it’s clear to me that our current system was in dire need of a fix.

It’s reasonable for an insurance policy to include a waiting period for existing conditions. If nothing else, it would discourage people from waiting until they get sick to buy in.

It is not reasonable that a person who survived a crippling, potentially fatal illness in early childhood, who grew up, got an education, and went on to become a productive citizen, should be penalized for the rest of her life.