Editorial: The GOP insists its healthcare bill will protect people with pre-existing conditions. It won’t

House Speaker Paul Ryan of Wis. pauses during a news conference about healthcare in Washington on April 4.
(J. Scott Applewhite / Associated Press)

About half of American adults under age 65 have at least one preexisting medical condition, by the federal government’s count. According to a Kaiser Family Foundation analysis, more than half of those adults could have been denied coverage by health insurers in the days before Obamacare if they weren’t included in a large employer’s plan.

That’s why one of the most popular and humane features of the 2010 Affordable Care Act is the provision barring insurers from discriminating against Americans with preexisting conditions. This provision not only saved many Americans from being bankrupted by medical bills, it relieved the anxiety that trapped people in jobs they would not leave for fear of losing coverage.

But now, House Republicans are proposing to let states punch a gaping hole in that safeguard as part of a bill to partially repeal and replace the ACA.


GOP leaders insist that their bill would continue to bar insurers from denying coverage to anyone, and that it would prevent them from jacking up the premiums for anyone who’d maintained continuous coverage even in states that waived the ACA’s protections for those with preexisting conditions. Consumers using those states’ insurance exchanges who did not maintain coverage would be eligible for subsidized state “high risk pools,” where high premiums would be offset by billions of dollars in federal aid.

But far more people would be likely to face huge premium increases than the bill’s supporters acknowledge. Millions of people enter and leave the state insurance exchanges annually — the turnover at Covered California is 40% to 50% — which means there may be millions of people going briefly uninsured and then facing enormous premium surcharges, if enough states dumped the ACA’s protection for preexisting conditions. According to one estimate, those surcharges could range from $4,000 per year for asthmatics to $17,000 for women seeking maternity coverage to $143,000 for those with a history of metastatic cancer.

The bill’s sponsors ponied up more aid Wednesday in an effort to make insurance affordable for all those Americans, but the measure’s funding would fall far short of the amount needed to do so — almost $200 billion short over 10 years, even if only 5% of those in the state exchanges fell into the high risk pool, the Center for American Progress has projected. No surprise there — exorbitant costs sunk the high-risk pools that states used before the ACA, even though they excluded many applicants and denied coverage for some costly conditions.

This is the history that we left behind when the ACA was adopted, and rightly so. It would be foolish to go back now.

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5:37 a.m.: This editorial was updated to clarify that the House healthcare bill would let states waive the protections for preexisting conditions.