If health insurers revert to pre-Affordable Care Act medical underwriting practices in the event of an ACA repeal, millions of people could become uninsurable in the individual markets, according to a new analysis.
The Kaiser Family Foundation estimated that as many as 52 million adults younger than 65—or 27% of that population—have pre-existing conditions that would likely disqualify them from receiving individual market coverage in a pre-ACA world. These deniable conditions include arthritis, cancer, sleep apnea, stroke and even pregnancy.
As of 2015, only about 8% of the non-elderly population had individual market insurance. The rest, who have employer-based plans or are insured through public programs like Medicaid, are exempt from underwriting regardless of what happens to the ACA. But they would be out of luck if they ever were to lose that coverage due to a job loss, divorce or other life change that affects eligibility.
President-elect Donald Trump has said he would like to keep a few of the ACA’s more popular provisions—including its ban on denying coverage due to pre-existing conditions.
But in order to keep such reforms and get rid of the requirement that everyone purchase health insurance, “we need to find alternative ways for people to get and stay covered,” America’s Health Insurance Plans CEO Marilyn Tavenner wrote in a recent op-ed for The Washington Post. Either that, or insurers will have to raise premiums to account for the fact that only those with immediate medical needs buy insurance, she argued.
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AHIP suggested turning to “continuous coverage incentives” used by Medicare and private employers such as waiting periods or penalties for people who have break in coverage.
Indeed, “there is bipartisan desire to protect people with pre-existing conditions,” the KFF analysis concluded, “but the details of replacement plans have yet to be ironed out, and those details will shape how accessible insurance is for people when they have health conditions.”