The long-awaited GOP plan for replacing the Affordable Care Act states that “no American should ever be denied coverage or face a coverage exclusion on the basis of a pre-existing condition,” but there is a catch that could make coverage unobtainable for people with health problems.
Under the ACA, plans can vary premiums based only on age, and they are limited to charging older people no more than three times what younger people are charged.
The plan that House Speaker Paul Ryan unveiled this week, like many conservative proposals that have come before it, protects people from being charged higher premiums because of their health status only if they have not had a gap in coverage.
A study by the Commonwealth Fund found that more than 35% of Americans between the ages of 4 and 64 were uninsured for at least one month from 2004 to 2007. Those with family incomes below 200% of the poverty level were far more likely to be uninsured for at least a month. The plan from House Republicans does not specify how long the coverage gap would need to be before premiums could change based on health.
Nearly half of uninsured adults in 2014 said cost was the main reason they did not have coverage. The Government Accountability Office found that anywhere between 36 million and 122 million adults had pre-existing conditions in 2012.
Under the GOP plan, someone with a pre-existing condition who loses insurance because of unemployment or other reasons would likely face even higher premiums after being without coverage. Those people would be directed toward high-risk pools, where premiums have usually been higher than average. The plan proposes $25 billion in federal money for the high-risk pools over 10 years. But one estimate suggested that amount may be needed annually to support the costs, and even supporters of the idea have said more than the proposed amount would be needed.
Sarah Lueck, senior policy analyst at the Center for Budget and Policy Priorities, wrote in a blog post that such a provision “wouldn't likely provide anything close” to the same protections as the ACA.
“ 'Continuous coverage' would thus protect people far less than the ACA, and only modestly more than the rules in place before it,” she wrote. “Many people would fall through the cracks.”
The Republican plan keeps the ACA's popular provision allowing children to stay on their parents insurance until age 26, but it does away with the ban on annual financial limits on policies and does not contain any minimum coverage requirements for plans.
