In the wake of failed efforts to gain support for their health plan last month, the White House is negotiating to put repeal of the Affordable Care Act (ACA) back on the table. While the previous proposal would have already driven up health care costs and stripped millions of coverage, the new proposal is reported to include provisions that would undo protections for the more than 130 million Americans who have a pre-existing health condition.
Supporters of eliminating these protections are now discussing a provision that is effectively a sick tax on premiums: People with health conditions would be charged multiples more based on their medical histories, requiring them to pay significantly more for coverage. Even if the new plan preserved the ACA’s rules on guaranteed issue—meaning that issuers cannot deny coverage—consumers with pre-existing conditions could still be priced out of the market.
Prior to the ACA, insurers could discriminate against anyone based on their current health conditions and medical history. People with common ailments, including asthma and high blood pressure, were charged higher rates. People with histories of serious conditions, such as cancer or heart attacks, were regularly denied coverage altogether.
About half of nonelderly Americans have one or more pre-existing health condition, according to a recent brief by the U.S. Department of Health and Human Services (HHS) that examined the prevalence of conditions that would have resulted in higher rates, condition exclusions, or coverage denials before the ACA. Approximately 130 million nonelderly people have pre-existing conditions nationwide, including nearly 1.3 million in Iowa. As shown in this table, there is an average of more than 300,000 per congressional district. Nationally, the most common pre-existing conditions were high blood pressure (44 million people), behavioral health disorders (45 million people), high cholesterol (44 million people), asthma and chronic lung disease (34 million people), and osteoarthritis and other joint disorders (34 million people).
While people with Medicaid or employer-based plans would remain covered regardless of medical history, the repeal of protections for pre-existing conditions means that the millions would face higher rates if they ever needed individual market coverage. The return of this kind of discrimination would hurt older Americans the most. As noted earlier, about 51 percent of the nonelderly population had at least one pre-existing condition in 2014, according to the HHS brief, but the rate was 75 percent for those ages 45 to 54 and 84 percent among those ages 55 to 64. But even millions of younger people, including 1 in 4 children, would be affected by eliminating this protection.
Eliminating pre-existing condition protections would undermine the fundamental purpose of health insurance, including providing both the healthy and sick access to care and protecting families from financial ruin.
Medical history should not be a barrier to affordable coverage.