More than 1 in 4 adult Americans have a pre-existing condition that could once again make it difficult for them to find health coverage if Republicans follow through with their pledge to dismantle provisions of the Affordable Care Act.
The Kaiser Family Foundation released a report Monday that shows about 27% of Americans younger than 65—or 52 million people—have one or more health conditions that would make them uninsurable in the individual market if underwriting practices revert to pre-ACA norms.
President-elect Donald Trump and Republican leaders who will soon control both chambers of Congress have said their promised repeal of the ACA will happen immediately in the new year, likely before a solid plan for replacement is put forward.
Health insurance companies, hospitals and patient advocates have all warned of potential chaos if the ACA is repealed without a replacement plan ready to implement. Estimates show about 22 million people losing coverage and the KFF brief adds more concern.
Most Republican ideas for replacement would protect people with pre-existing conditions as long as they maintain continuous coverage. Those who lose coverage for long enough, however, would be vulnerable.
House Speaker Paul Ryan said there would be a transition period away from the ACA so that “no one is worse off” but has not detailed how it would work.
Trump has previously waffled on how much of the ACA he would repeal and has praised provisions that protect those with pre-existing conditions. In a primary debate, Trump said he would keep the protection and said that insurance companies shouldn't need an individual mandate in order to maintain the protection.
While most of those people are covered through their employer or a government program such as Medicaid that does not discriminate against those with pre-existing conditions, they might be vulnerable after a job loss, divorce or early retirement.
The rate of people affected varies from state to state, according to the KFF brief. In seven states at least one-third of the non-elderly population would have declinable conditions. All of those states went for Trump and his promise of repealing the ACA in the presidential election.
The authors say the results are conservative because available data did not include all declinable conditions and doesn't attempt to include deniable medications or declinable occupations.
A separate KFF poll found that more than half of those surveyed said someone in their household has a pre-existing condition.
Previous polls have shown strong support for not allowing discrimination against people with pre-existing conditions. Even 69% of self-identified Republicans wanted such protections. The authors of the KFF brief write that they hope whatever is in place will heed the public's concern.
“There is bipartisan desire to protect people with pre-existing conditions, 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,” they wrote.