At that time, the Affordable Care Act had been passed, but most of its key provisions hadn’t kicked in. Insurers could charge different prices to customers, depending on their health history. And patients who were shut out of the traditional market had access to a high-risk pool.
Researchers at the Kaiser Family Foundation studied an “underwriting guide” that the insurance company Anthem used back then to sell health plans in Indiana, Kentucky and Ohio. The guide explained how people could apply for health insurance, and how their prices might change, depending on their answers to questions.
There were a lot of questions. In addition to a multi-page form, asking about prior diagnoses, prescriptions, height, weight, occupation and other details, many customers were asked to fill out supplementary questionnaires about their health problems. Anyone who answered “yes” to a question about a history of allergies, for example, would get follow-up questions — and sometimes be asked for more medical records or a doctor’s note.
Customers were slotted into different categories, depending on their answers. The most healthy were called “Super Preferred,” and could get a 7 percent discount on the standard premium. The least healthy were called “Modified 5,” and were charged three times the standard rate. (This was at a time when anyone receiving treatment for, say, acne or osteoarthritis, or with blood cholesterol above 260, could be denied coverage altogether, so least healthy was relative.)
Height and weight calculations also affected premium prices, and not just for adults. If your child was 3 feet 2 inches tall and weighed more than 62 pounds, the…