Premium Increases for Pre-Existing Conditions Under Latest ACA Repeal Plan, by State

Hundreds of people march through downtown Los Angeles protesting President Donald Trump's plan to dismantle the Affordable Care Act, March 23, 2017.

Repealing protections for people with pre-existing health conditions could be on Congress’ agenda as early as next week. Facing pressure from the Trump administration, Congress may be ready once again to try to repeal the Affordable Care Act, or ACA. This time around, Congress is discussing including an amendment that would allow insurance companies in the individual market to charge higher rates to consumers based on health status.

Under the deal that was leaked, states would be able to waive protections for pre-existing conditions for any reason, as long as they set up a high-risk pool or participated in a federal risk-sharing program. Before the ACA, all but seven states allowed insurance companies to charge higher premiums to people with pre-existing conditions.

Without pre-existing condition protections, health care would become prohibitively expensive for those who need it most. People with asthma, a relatively minor chronic condition, would face a markup of about $4,000 for coverage, while those with severe illnesses such as heart trouble or cancer would face premiums tens of thousands of dollars above standard rates.

The cost of care varies by state, and health insurance costs do too. The Center for American Progress has estimated the premium surcharges that consumers in each state—and the District of Columbia—would face for five conditions under the new congressional Republican proposal: breast cancer; pregnancy; major depression; diabetes; and asthma. We have also accounted for the federal risk-sharing program that Republicans in Congress have put forward as a means of limiting premium increases. The numbers in the table are the average increases that people currently experiencing the listed conditions would pay on top of the standard rate for health coverage, including the new risk-sharing program.

However, as evidence from before the passage of the ACA shows, insurance companies would also set rates based on previous ailments. More than 130 million nonelderly Americans have pre-existing conditions, and the return of rating on health status would subject them to thousands of dollars of extra expenses for individual market coverage.

Seven states had pre-existing condition protections in place before the ACA: Maine; Massachusetts; New Jersey; New York; Oregon; Vermont; and Washington. We assume that these states would not seek an AHCA waiver to allow rating based on health status and therefore did not calculate health-based surcharges for these states.


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