Opinion: Remember when you couldn’t get insurance with a preexisting condition? Those days are probably coming back

A woman at a town hall meeting held by Rep. Ami Bera laments the possible loss of her family's ACA coverage in Elk Grove, Calif. (Autumn Payne / Associated Press)
(Autumn Payne / Associated Press)

Raise your hand if you want to go back to the days when you couldn’t get health insurance because you’d been sick or injured.

That’s one of the galling possibilities raised by the evolving version of the American Health Care Act, the House GOP leadership’s plan to repeal and replace Obamacare. The blame lies with the changes that President Trump and House leaders reportedly pledged to make in the bill to win the support of members of a group of far-right House members, the Freedom Caucus.

The measure already was designed to save money for the young and hearty at the expense of the older and ailing. But the changes would give insurers more latitude and incentive to divide Americans once again according to their health, and to price the coverage needed by those with costly preexisting conditions so high that few could afford it — if insurers offer it at all.


No wonder moderate Republicans in the House and Senate are blanching. By late afternoon Thursday, House leaders had postponed a planned vote on the proposal to give them more time to drum up the necessary support.

Naturally, the plan’s sponsors insist that it would continue to protect people with preexisting conditions. But even as they retained Obamacare’s requirement that insurers accept all applicants without basing premiums on their health histories, they would make it easier for insurers to penalize people for having the audacity to survive cancer, be born with diabetes or suffer from a chronic disease.

That’s because the sponsors have reportedly promised to eliminate the mandate in Obamacare (formally known as the Patient Protection and Affordable Care Act) that insurance policies cover a comprehensive range of “essential health benefits,” such as maternity care, hospital costs and preventive health screenings. Yes, that requirement made insurance more expensive for those not covered by large employer plans. The point, though, was to bring thousands of individuals together into a single risk pool, where costs could be spread more broadly.

The GOP plan would abandon this risk-sharing in favor of an every-man-for-himself approach to coverage, allowing insurers to offer a range of plans — less expensive ones replete with exclusions and more costly ones that cover more conditions. The former would appeal only to healthy customers or at least those willing to gamble on going a year without major injuries or illnesses.

That’s what insurers did in the days prior to the ACA — a time when insurers could deny coverage to people with preexisting conditions, and yet premiums were rising at double-digit rates anyway, as Republicans seem to forget.


With the changes promised to the Freedom Caucus, however, the House bill could make life even worse for people with preexisting conditions. Required to accept all applicants but not cover all major risks, insurers would have a tremendous incentive not to offer coverage for costly conditions — pregnancy, for example, or lymphoma. And if they did offer coverage, it would likely be in hugely expensive specialty plans, considering that the only people signing up for them would be those most likely to need care.

Insurers have always tried to minimize their exposure to consumers with preexisting conditions, which is why the ACA’s protection of those consumers proved so popular. By dropping the essential health benefits mandate, the House GOP bill would give insurers a new way to avoid covering those consumers or at least avoid providing the coverage for any costly treatments that those consumers might need.

Granted, it’s not just the Freedom Caucus that have members appear to be fine with that outcome. Witness the befuddlement Rep. John Shimkus (R-Ill.) expressed over why men should have to help pay the cost of prenatal care.

There’s no doubt that the ACA hasn’t been implemented well in a number of states, particularly ones led by Republicans hostile to the ACA. In those areas, not as many younger, healthier people signed up for coverage as insurers anticipated. That caused premiums to jump, in some areas sharply. Some insurers also pulled out of the market in those regions, leaving consumers with few choices for coverage.

Lawmakers could address the complaints about rising premiums and dwindling choice without gutting the ACA, but that’s not the direction Republicans are headed. House GOP leaders’ initial choice was bad enough — the original bill would let insurers sell comprehensive policies that cover a smaller percentage of their customers’ medical bills. But the new plan is even worse, encouraging insurers to sell cheap but narrow policies that don’t cover costly treatments or drugs while charging exorbitant premiums for comprehensive coverage.

In other words, they want to turn the clock back to a time we thankfully left behind when President Obama signed the ACA seven years ago, and then make things worse. This is one Throwback Thursday that’s not worth observing.

Twitter: @jcahealey


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12:50 p.m.: This post was updated to note that the House vote on the healthcare bill had been postponed.