July 27--More than 3.8 million Floridians who have pre-existing medical conditions will be eligible for health-insurance coverage when the health-care-overhaul law takes effect in January 2014, according to a report released Thursday from Families USA, a consumer-health group.

One in four Floridians younger than 65 has a health condition that could result in coverage denial, said the report, which looked at 69 medical and mental conditions insurance companies use to deny coverage. Those age 65 and older receive coverage under Medicare.

Among the more common conditions included are heart disease, cancer, lung disease, obesity and diabetes.

Under the health-care overhaul, Americans cannot be denied coverage, charged a higher premium or sold a policy that excludes coverage for services related to their condition, said Ron Pollack, executive director of Families USA.

Children with pre-existing conditions already are already covered by the new law, upheld last month by the U.S. Supreme Court.

The news came as a relief to Hector Alacron of Winter Park, whose pre-existing condition made it impossible for him to get insurance. The 58-year-old restaurant owner was diagnosed with Type 1 diabetes when he was 40. For most of the years since, he has been uninsured, although he pays $750 a month for individual group health insurance to cover his wife and three teenage sons.

Last year, he finally found an insurance plan that would cover him for $700 a month, but it would not cover any issues related to his diabetes.

"I didn't do it," he said. "It's not right to pay for insurance and not get help for my sickness."

Alacron is among the 232,700 Orange County residents -- 23.2 percent -- who could benefit from the expanded protections, according to the report, which broke down populations with pre-existing conditions by county.

In Osceola County, 53,400 residents, or 23.1 percent, have pre-existing conditions. In Seminole County, 24.7 percent of the population, or 89,900 residents, will be assured coverage, as will 105,400 residents in Volusia (28 percent) and 58,200 in Lake (26.8 percent).

Throughout the state, the percentages of those who have medical conditions that could prevent coverage range from 22.6 percent of residents in Miami-Dade and Monroe counties to 32.6 percent in Citrus and Sumter.

The chances of developing a pre-existing condition increase with age, report authors said. Almost one in five 18- to 24-year-olds (18.8 percent) have a pre-existing condition. About a third of those ages 35 to 44 do (30.5 percent) and nearly half (48.1) of those 55 to 64.

All of them will soon "be protected from discrimination and have security and peace of mind," said Pollack.

'Wildly misleading'

Not everyone sees it that way. Ed Haislmeier, senior health-policy analyst for the Heritage Foundation, a conservative think tank in Washington, calls the report "wildly misleading."

Though he doesn't dispute the numbers of Floridians who have pre-existing conditions, he said "the organization is using the information in a very disingenuous way."

More than 90 percent of these individuals are in the employer group market, where the law for 15 years has protected them from denials of coverage, he said, referring to the Health Insurance Portability and Accountability Act passed in 1996.

For the remaining 9.4 percent, Haislmeier said, "the problem could be tackled with modest reform and modest dollars, not massive restructuring to the system that will cost a trillion dollars of new spending."

Though it's "absolutely true" that most of these 3.8 million have coverage, "that's not the point," Pollack said. "What we're saying is that all of them are at risk of not having coverage if changes occur in their work situation."

When Americans can't get health coverage, they often delay or forgo care; are less likely to get preventive care and screenings; and are less likely to have a primary-care doctor, so they use the emergency room more.

Guaranteed coverage for those with pre-existing conditions is one of the most popular aspects of the new health-care plan, said Laura Goodhue, executive director of Florida CHAIN, a consumer-health advocacy organization. "[The provision] takes care of insurance practices that have been discriminatory for a long time."

Until the law goes into effect, some uninsured Floridians denied insurance because of pre-existing conditions may qualify for a bridge plan, Goodhue said. The Pre-existing Condition Insurance Plan started as a result of the health-care-overhaul law in 2010.

In March, Alacron tried a new insurance broker who suggested he apply for a PCIP. He qualified.

"Wow! Was I surprised. I got a card and everything," Alacron said.

Under the federal program, he pays $376 a month, and the plan covers diabetes care. The insurance went into effect March 1, and just in time. On March 6, Alacron suffered a stroke, which resulted in a $30,000 medical bill.

"I paid $2,000 out of pocket, and the rest was covered," he said.

If he hadn't had coverage, he said, "I don't know what would have happened. I would have gotten a $30,000 bill and tried to pay what I could pay."

Some face 'job lock'

Not everyone with a pre-existing condition qualifies for the federal bridge program.

Candice Brown of Palm Beach is one. The 53-year-old, self-employed geriatric-nurse coordinator pays $1,150 a month for her health insurance, a lot more than most because she has Crohn's, a chronic intestinal disease.

She can't get PCIP because to qualify, Americans must be uninsured for six months.

"I can't be without insurance for six months. I don't want to take the risk," she said.

Diagnosed 30 years ago, Brown had insurance until 2006, when she closed a small business she owned and through which she had group insurance for herself and her employees. When she went solo, her insurance ended.

COBRA covered her for six months, and then she frantically shopped for another plan. Though she's had no surgeries related to her chronic disease, takes no drugs and is in remission, she said, "nobody would insure me. I must have called 30 companies. Crohn's is a huge red flag."

She finally found a "conversion plan" that would cover her for double the premium she had been paying.

It's expensive, and she's looking forward to the new law taking effect and cutting her monthly premium in half. "I've looked into what my rates will be. For my age the rates are between $500 and $600 a month, regardless of my condition."

She has considered going to work for a larger employer just to get the insurance.

"But I've worked on my own for 15 years," Brown said. "I don't want to be held hostage to a job."

Others with pre-existing conditions don't have that option. Instead, they find themselves in "job lock," a situation where workers are stuck in a job because they may not be able to get any insurance if they leave.

"People are trapped," Brown said. "And it's scary."

mjameson@tribune.com or 407-420-5158

___

(c)2012 The Orlando Sentinel (Orlando, Fla.)

Visit The Orlando Sentinel (Orlando, Fla.) at www.OrlandoSentinel.com

Distributed by MCT Information Services