Fallacy of pre-existing condition protection

The Patient Protection and Affordable Care Act of 2010, usually referred to as the ACA, or Obamacare, prohibits discrimination by insurance companies “based on . . . preexisting conditions or health status.” Prior to the ACA, people with chronic health conditions were subject to medical underwriting; insurance companies could exclude medical conditions from coverage, and could charge unaffordable premiums. The ACA prohibits “any preexisting condition exclusion”; it also prohibits denial of coverage or “discriminatory premium rates” based on health status. The Government Accountability Office estimates that 80 million Americans have medical conditions that would make them subject to medical underwriting (GAO-12-439, Mar 27, 2012.). When the Affordable Care Act became law, these people had access to affordable coverage, many of them for the first time. Over two million Pennsylvanians with preexisting conditions will lose this protection if the ACA is repealed.

I lost my job in 2011, and in 2013 I exhausted the COBRA extension that allowed me to stay on my former employer’s plan. Any insurance I could find after that came with unaffordable premiums because I have epilepsy; in any case, it would have excluded coverage for this disease. The medicine I take to manage my seizures costs over $800 a month. Happily, the ACA’s preexisting condition protections became available at the beginning of 2014 and I was able to enroll in an affordable health plan.

Republican plans that have been proposed to “replace” the ACA claim to maintain protections for individuals with preexisting conditions. This is a popular provision of the ACA, and Republicans are careful to include it in their plans. Speaker of the House Paul Ryan has published a detailed outline for a healthcare plan on his “A Better Way” website. In his plan, Ryan states that, “no American should ever be denied coverage or face coverage exclusion on the basis of a preexisting condition.”

But Ryan’s plan greatly limits the number of Americans with preexisting conditions who would be guaranteed coverage. “This new safeguard,” he says, “applies to everyone who remains enrolled in a health insurance plan.” Under Ryan’s plan, I would have been subject to exclusions and medical underwriting in 2013 because I didn’t have health insurance for most of that year.

The Empowering Patients First Act was introduced by Rep. Tom Price, President Trump’s new Secretary of Health and Human Services last year. It is similar to Ryan’s plan in many ways, including the way each treats preexisting conditions. Like other Republican plans, this bill prohibits insurers from “impos[ing] any preexisting condition exclusion.” But only if the “enrollee has at least 18 months of continuous creditable coverage.” Again, I wouldn’t have been able to find insurance after I lost my job because I went uninsured for a period of time. Price goes further and allows insurance companies to charge patients with preexisting conditions a premium surcharge “that does not exceed 150 percent of the applicable standard rate.” This is not a protection for those of us who can’t afford such exorbitant rates and who find themselves unable to maintain continuous coverage.

In defending his vote early this year for the Budget Resolution that would begin the process of repeal, Rep. Ryan Costello of the 6th district perpetuates the myth of preexisting condition coverage. “The way to improve our healthcare system,” he says on his website, is by “expanding access to care . . . especially to those with preexisting conditions.” Indeed, a bill that addresses preexisting conditions is now being drafted in Costello’s Energy and Commerce Committee.

It does what these other plans do: the draft prohibits preexisting conditions exclusions. But unlike the ACA, it doesn’t prohibit exorbitant premiums. And by calling it the “The Preexisting Conditions and Continuous Coverage Incentive Act,” Republican lawmakers make it clear that this bill will guarantee coverage for patients with preexisting conditions only if there is no lapse in coverage. According to the Department of Health and Human Services, about 23 percent of Americans experienced at least one month without insurance coverage in 2014 (ASPE Issue Brief, Jan. 2017).

For a great many Americans with chronic health conditions and limited financial means, health insurance was not accessible and not affordable before the Affordable Care Act.

If the law is repealed, and replaced with any of the existing Republican plans, people with preexisting conditions will have the same options as they had before the ACA—most will be unable to buy health insurance. Doug Gunn Phoenixville