Revised Republican health bill could imperil coverage for sick plan members

WASHINGTON—The latest proposal to replace the Affordable Care Act has become a much harder sell for Republican moderates who will determine whether the bill passes the House of Representatives in a possible vote later this week.

Their main sticking point: concerns about how a new amendment could weaken consumer protections, particularly for people with pre-existing medical conditions.

The proposal would allow states to opt out of the ACA’s “community rating” rule that prohibits individual insurers from charging sick people more for coverage.

In states that receive federal waivers under the proposal, individual insurers could base the cost of coverage on a person’s health status or medical history using a process known as medical underwriting, which was discontinued under Obamacare.

Although people with medical problems couldn’t be denied coverage under the amendment, the return of “health status underwriting could effectively make coverage completely unaffordable to people with pre-existing conditions,” wrote Dr. James L. Madara, CEO of the American Medical Association, in a letter to congressional leaders last week.

That could lead to an explosion of cheaper bare-bones coverage plans with skimpy benefits in states that also use the amendment to waive the ACA requirement that insurers cover ten essential health benefits.

“Legislation drafted with the singular goal of bringing down premiums without regard to adequate or equitable coverage fails the majority of Americans who at some point become sick and need comprehensive coverage,” said a similar letter to congressional leaders by Chris Hansen, President of the American Cancer Society Cancer Action Network.

More than 2.9 million people, or 27 percent of people with individual coverage in 2014, had a pre-existing health condition before enrolling in coverage, according to federal estimates. The number jumps to nearly 6 million, or 55 percent, under a broader interpretation.

The most common conditions for working-age adults are high blood pressure, high cholesterol, obesity, asthma, acne, arthritis and behavioral problems like substance abuse disorders and depression. More serious conditions include cancer, heart disease, diabetes, pregnancy, epilepsy, AIDS and kidney disease.