Experts: Coverage would fall far short

The $23 billion included in the House Republican plan to repeal the Affordable Care Act to pay for people with pre-existing chronic health conditions will cover only about 5% of the estimated 2.2 million people who need insurance, an analysis concluded.

The funding wouldn’t come close to covering people with individual insurance plans in Texas or Florida, health care consulting firm Avalere said.

Many of these people, whose problems could be as simple as acne or as serious as late-stage cancer, were either banned from buying insurance before the ACA took effect or found that whatever insurance they could buy was too expensive.

The Republican plan, called the American Health Care Act, would revive “high-risk pools,” pots of money set aside for people whose health conditions make buying insurance very expensive. Before the ACA, when these patients could get insurance, they faced high deductibles and very high out-of-pocket costs, said Adams Dudley, a physician and director of the Center for Healthcare Value at the University of California-San Francisco.

The bill would allow states to apply for a waiver to permit insurers selling policies to charge people more money if they let their insurance lapse and if the state created a program to help “high risk” (read: really sick) patients buy insurance. The patients could use the money from the “high risk” pools to buy insurance.

The proposed program would allow only a few small states to opt into coverage for people with pre-existing conditions, said Avalere Senior Vice President Caroline Pearson. If a large state received a waiver, “many chronically ill individuals could be left without access to insurance,” she said.