Ask Nancy: Where can I find health insurance if I have a pre-existing health problem?

A. Yes, but not until Jan. 1, 2014, when the Affordable Care Act is—finally!—fully implemented. Starting then, it will be against the law for insurers to turn you down or charge you more on the basis of your health condition. You can give up your current job free of that worry (and may even qualify for a subsidy to help your new small business buy coverage for employees).

In the meantime, you have lots of company. Up to half of Americans 65 and younger—129 million in all—have health conditions that could cause them trouble buying insurance on the individual market, according to a study released today by the U.S. Department of Health and Human Services.

The timing of the report's release on the same day that House Republicans begin consideration of a bill to repeal the health reform law is no accident, said HHS Secretary Kathleen Sebelius in a press conference. "We're using it as an opportunity to remind people of what's at stake," she said.

In fact, right now, you have literally no chance of buying private health insurance in California (where you said you live) on the open market at an affordable premium. There and in most other states, insurers automatically turn down people with type 2 diabetes, even if they have their condition under control and follow proper diet and exercise habits.

Until the reforms kick in, you do have a few options, though they're going to be more expensive than what you have through your employer. (Thanks to the Georgetown University Health Policy Institute's invaluable state health insurance guides for the details to follow.)

• If your current employer has 20 or more workers, you can quit your job and maintain your current coverage through COBRA for 18 months, but you'll have to pay the full premium yourself.

• Once your COBRA runs out, you can extend it another 18 months through Cal-COBRA, provided that your former employee plan was fully-insured and not self-insured (your employee benefits office can tell you what kind you have). Again, you'll be paying the entire tab. If you work for a company with fewer than 20 workers and are therefore ineligible for regular federal COBRA, you can take Cal-COBRA for 36 months.

• If you're not eligible for Cal-COBRA, you can switch to a private plan after your federal COBRA runs out under a provision of the federal HIPAA law that more people should know about. It guarantees people leaving employer group coverage the right to buy designated private plans without excluding their pre-existing conditions. The catch, and it's a big one, is that the insurer can and undoubtedly will charge you considerably more if you're not in perfect health.

• You can also obtain coverage from California's state high-risk health insurance pool, MRMIP, but it's likely to be more expensive than what you have now and has an annual benefit cap of just $75,000. If your wife and children are in good health, you might consider getting MRMIP coverage for yourself and a regular individual policy for the rest of the family.

 —Nancy Metcalf, senior program editor

—Joel Keehn