TAILIEUCHUNG - Estimates of Individuals with Pre-Existing Conditions Range from 36 Million to 122 Million

The IRS will be responsible for enforcing the mandate and collecting fines. By January 31 each year, the agency will receive enrollment information from private insurers and public programs for the previous calendar year; that information will include the name and Social Security number of every person covered by each plan and the dates of coverage. Policyholders will receive similar information from insurers. The exchanges will be required to report to the IRS the name and taxpayer identification number of every person who receives an affordability or hardship exemption. The reporting requirements should provide the IRS with the tools it needs. | United States Government Accountability Office GAO March 2012 Report to Congressional Requesters PRIVATE HEALTH INSURANCE Estimates of Individuals with Pre-Existing Conditions Range from 36 Million to 122 Million GAO-12-439 March 2012 ÀG AO Accountability Integrity Reliability Highlights Highlights of GAO-12-439 a report to congressional requesters Why GAO Did This Study Individuals who buy coverage directly from a health insurer are often denied coverage due to a pre-existing condition during a process called medical underwriting which assesses an applicant s health status and other risk factors. Beginning January 1 2014 the Patient Protection and Affordable Care Act PPACA prohibits health insurers in the individual market from denying coverage increasing premiums or restricting benefits because of a pre-existing condition. GAO was asked to examine the effect of this provision on adults who are 1964 years old. GAO examined 1 the most common medical conditions that would cause an insurance company to restrict or deny insurance coverage for adults and the average annual costs associated with these conditions 2 estimates of the number of adults with pre-existing conditions and 3 the geographic and demographic profile of adults with pre-existing conditions. To address these three issues GAO 1 identified four recent studies that narrowly or more broadly identified five lists of conditions likely to result in restricted coverage in the individual insurance market and 2 used the 2009 Medical Expenditure Panel Survey to generate five separate estimates referred to as estimates 1 through 5. There is no commonly accepted list of pre-existing conditions because each insurer determines the conditions it will use for medical underwriting. We also contacted state insurance department officials in all 50 states and the District of Columbia to confirm information about state insurance protections that currently limit or prohibit medical underwriting. View GAO-12-439. For more .

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