› Bad news on pre-existing conditions,

The Republican push to replace the Affordable Care Act was revived this week in Congress by a small change to their plan designed to combat concerns over coverage for those with pre-existing health problems.

The change helped get the bill through the House of Representatives in a tight vote Thursday, but experts say it may make little difference in the hunt for affordable coverage for those patients.

The bill proposes setting aside an additional $8 billion over five years to help states cover those who may be subject to higher insurance rates because they’ve had a lapse in coverage. That’s on top of about $100 billion over a decade for states to help people afford coverage and stabilize insurance markets. The problem, experts say, is that the money is unlikely to guarantee an affordable alternative for those who get coverage under a popular provision of the Affordable Care Act that prevents insurers from rejecting people or charging higher rates based on their health.

John S. Williams, an attorney in New Orleans whose multiple sclerosis medication costs $70,000 a year, buys insurance through the Affordable Care Act’s marketplace. Without protections for pre-existing conditions he fears he would have to close his law practice and find a job that offers a group insurance plan.

Here’s how coverage may change for those with pre-existing conditions under the plan:

WHAT CHANGES?

States will be able to get federal waivers allowing insurers to charge higher premiums to people with pre-existing illnesses who have let their coverage lapse. States can then use federal money to fund government-operated insurance programs for expensive patients called “high-risk pools.”

HOW DO THE POOLS OPERATE?

Patients who couldn’t get or afford insurance could apply for coverage through those high risk pools, which existed before the Affordable Care Act was passed. Even though they were charged far higher rates, up to double the amount paid by consumers with no serious ailments, care for these patients is so expensive that government money was needed to fund the programs.

DO THEY WORK?

In the more than 30 states that had high-risk pools, net losses piled up to more than $1.2 billion in 2011, the high point of the pools before the Affordable Care Act took full effect. Medical expenses outpaced premiums collected, and losses averaged $5,500 per person enrolled.

IS THE FEDERAL MONEY ENOUGH?

An analysis by the health care consulting firm Avalere found that the money would only be enough to fund highrisk pools in a few small states. High-risk pools could fill up fast with patients who have a lapse in coverage.

About 2.2 million people in the individual insurance market have some sort of pre-existing chronic condition, according to Avalere.

WHAT MIGHT THIS MEAN FOR PATIENTS?

Because the bill is expected to change, and because it leaves big decisions up to the states, it’s hard to say now what it would mean.

Proponents of the bill note that people in poor health would be protected as long as they maintain coverage. If they don’t, the higher premiums would revert back to standard rates after 12 months, assuming the customer could afford to keep paying.

In the past, states have established waiting lists to get into their risk pools, since they have to balance their budget and they have no way to predict how high costs will climb.