The study determined 41 percent of non-elderly adults living in the Kingsport and Bristol region have a pre-existing condition, meaning they would be denied individual market insurance coverage prior to the Affordable Care Act becoming law.
The next closest region analyzed, Knoxville, showed 30 percent of non-elderly adults with a pre-existing condition, while the Nashville-Davidson-Murfreesboro-Franklin area had a 27 percent rate. Of the 1.26 million non-elderly adults living in Tennessee, on average, 32 percent have a pre-existing condition.
So what is a pre-existing condition?
“In its simplest terms, it’s a health condition that exists prior to a person’s application for health insurance,” Todd Norris, Ballad Health senior vice president for community health and system advancement, said.
“When we go to seek health insurance, we will often be required, especially if we’re getting insurance outside the parameters of a work environment, to have some sort of physical examination or attest to any developed diseases or conditions we have. It ranges from alcohol abuse and drug abuse with recent treatment to something as drastic as hemophilia.”
Kaiser Family Foundation researchers made their estimates based on a review of pre-Affordable Care Act underwriting manuals that were used by insurers in the individuals market.
According to the study, some medical conditions that commonly led to a decline of coverage included AIDS, cerebral palsy, congestive heart failure, diabetes mellitus, epilepsy, sleep apnea, transsexualism, severe obesity, multiple sclerosis, mental disorders such as severe bipolar and eating disorders and pregnancy.
These conditions, and more, appeared on the declinable lists of at least half of the insurance guides analyzed.
Because Northeast Tennessee has a history of being ranked below-average in health indexes, Norris said the results were not entirely surprising.
“On one hand it is a surprise, and on the other hand it’s not because we see that unfortunately, when we see the County Health Rankings or America’s Health Rankings or the Gallup Well-Being Index come out, our region doesn’t fare as well as other parts of the country in the things that lead to disease and disability,” Norris said.
“So in terms of smoking rates being higher here, physical activity rates being lower, obesity rates being higher ... Those are the health behaviors that underpin whether someone is going to develop disease or not.”
According to the 2018 County Health Rankings, 22 percent of adults smoke in Sullivan County and 32 percent are deemed obese. The report also found 31 percent of people in Sullivan County reported no leisure-time physical activity.
Comparatively, Washington County reported similar figures in the 2018 County Health Rankings, with 21 percent of adult smokers, 29 percent of adult obesity and 32 percent physical activity.
Dr. Eric Harman, a family physician in Kingsport, also attributed the high rate of pre-existing conditions in Northeast Tennessee to poor diets and mental health diagnoses, particularly those related to addiction and substance abuse.
“We have a lot of smoking in the South, and the diet isn’t the best with the biscuits and gravy and all the foods we love to eat,” Harman said.
“That contributes to morbid obesity, which is definitely one of the prominent codes for people that are not Medicare age. We have some significant mental health challenges, too, and that feeds into the opioid crisis. It wouldn’t surprise me if that made up a lot of the troubles we see.”
While Harman said a heightened focus on properly coding medical diagnoses could factor into the high rate, Norris said it is also possible the rate is even higher than 41 percent, since some people likely have a pre-existing condition they are unaware of.
“Take diabetes for example. There are people who have Type 2 diabetes now who are not aware they have it, and it would discovered at a future time,” Norris said.
Harman said this analysis is just another reason why Tennessee lawmakers should expand Medicaid coverage.
“We should expand Medicaid in our state to better allow hard-working, self-employed people to obtain insurance under the ACA. What we know about chronic conditions is that managing them leads to more productive people with a higher quality of life and reduced overall health care costs — particularly to taxpayers,” Harman said.
Norris said the merger of Ballad Health and its renewed commitment to improving public health in the region will be vital to reversing these trends, but he said Ballad Health won’t be able to do it alone.
“It’s going to take all of us working together to make a difference in this, and it’s going to take some time because these trends were built over decades and it will take some time to reverse them. Frankly, the more people and organizations we have working together, the more quickly we’ll be able to get the trend moving in the right direction,” Norris said.
Ballad Health is currently working with other organizations in the region to form an “accountable care community.”
While Norris said more details about the initiative would be announced at a later date, accountable care communities are usually made up of stakeholders that share responsibility, resources and data to improve community health indicators.
“(Ballad Health) has committed to making an investment in improving the health status of our region over the next 10 years. We’ve committed to working with a host of other organizations throughout the region to drive collective action, community action and mobilization. One of the things that’s going to be the leading edge of all of this and a rallying point for us is the formation of an accountable care community,” Norris said.