As House Republicans frantically seek support for legislation to replace the Affordable Care Act, the biggest sticking point is whether the bill fulfills one of the GOP’s central pledges: preserving protections for people with pre-existing health problems.
More than a quarter of adult Americans under 65 have a pre-existing health issue, which includes everything from asthma and diabetes to heart disease and cancer, according to the Kaiser Family Foundation. Under current law, insurers cannot deny those or other sick people coverage or charge them more than healthy people. It's one of the ACA's most popular provisions.
President Donald Trump insists that the GOP’s American Health Care Act makes good on that pledge, and House Speaker Paul Ryan says on his website that “under no circumstance can people be denied coverage because of a pre-existing condition.”
But a recent amendment to the AHCA, authored by House Republican Tom MacArthur (shown above), from New Jersey, provides a loophole. It allows states to let insurers charge higher premiums to sicker people if their coverage has lapsed, and if the state has set up a so-called "high-risk pool," or special health insurance programs for sicker patients.
In a bid to garner more votes from moderate Republicans concerned about going back on their pledge to cover sick people, House Republicans said Wednesday they are discussing adding more funding for those high-risk pools.
But critics say that even with that extra cash those risk pools will be underfunded. And they point out that people with pre-existing conditions are especially likely to have gaps in insurance, because if they become too sick to work they may lose coverage through their employer, says Sara Collins, vice president of health care coverage and access at the Commonwealth Fund, a nonpartisan foundation that supports independent research on health and social issues.
And while those people may technically still have access to insurance, in practice it may be out of their reach. "If you can charge sick people whatever you want, that’s effectively denying people coverage,” says Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute, a nonpartisan health policy research group.
