Could pre-existing conditions rule be next target of ACA opponents?

As the debate continues regarding some of the more controversial parts of the Affordable Care Act--such as Medicaid expansion and the Cadillac tax--another unexpected provision now may also be under fire from the law's opponents.

The provision in question is the ACA's guarantee that individuals with pre-existing conditions cannot be denied medical coverage, according to an opinion piece in the L.A. Times. A 2014 poll, the article notes, found that the rule enjoyed considerable support across the political spectrum.

But the conservative-leaning Mercatus Center at George Mason University may be poised to change that, as it has recently convened economists and published papers to address what it deems "America's thorniest healthcare challenge." While these experts generally agree that it's necessary to provide some protection against medical underwriting, they disagree on how to replace the ACA's current rules.

Former U.S. senator Tom Coburn, M.D., for example, advocates a continuous coverage rule that would guarantee protection for medical conditions as long as the beneficiary maintains an active policy with no more than a brief break in coverage. Wisconsin Gov. Scott Walker, who is seeking the Republican presidential nomination, also advocates this concept.

Bradley Herring of the Johns Hopkins Bloomberg School of Public Health argues that the system should encourage health coverage with longer terms, writing that: "guaranteed-renewable insurance allows those with chronic health conditions to pay a pooled premium that is the same as that paid by those without chronic health conditions, but as a result of a voluntary decision to pool together rather than a regulatory requirement to do so."

But there are concerns with either plan, the Times piece notes. Because medical costs vary widely by region, it would be difficult for insurers to create a nationally portable long-term health plan. And the continuous coverage idea doesn't take into account the fact that most who drop coverage do so for financial reasons.

To learn more:
- read the opinion piece
- here's the Mercatus Center papers

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