KFF: AHCA could increase premiums for 6.3M people with pre-existing conditions

A projected 6.3 million people with pre-existing conditions could face higher premiums under the ACA replacement plan approved by the House, according to a new Kaiser Family Foundation analysis.

The House approved the GOP's ACA replacement plan, known as the American Health Care Act, May 4. Under the AHCA, states could seek waivers to opt out of the ACA's community rating rule, which bars insurers from charging different premiums "based on age, gender, health status or other factors." Insurers in states with these community rating waivers could charge higher premiums to enrollees based on health status, and who have had a gap in insurance of 63 or more consecutive days in the past year, according to the analysis. States with community rating waivers would have to set up programs such as a high-risk pool to help make coverage affordable for consumers, or participate in a reinsurance arrangement.

For the analysis, KFF calculated nationwide prevalence rates of declinable health conditions based on the CDC's 2015 National Health Interview Survey. The KFF analysis estimates 6.3 million people have a pre-existing condition that would have been declined prior to the ACA and would lead to a substantial premium surcharge in states with community rating waivers. The projection includes 23 percent of the estimated 27.4 million U.S. non-elderly adults who had at least a several-month insurance coverage gap in 2015.

KFF said its estimates might understate or overstate the number of people with pre-existing conditions who could face premium hikes under the AHCA. The analysis notes in states with community rating waivers, people with health conditions would be incentivized to maintain continuous coverage so they could still afford their premiums. However, it is unclear how many would be able to afford continuous coverage, given that premium tax credits under the AHCA would be 36% lower on average for marketplace enrollees than under the ACA.

Additionally, KFF estimates 3.8 million adults with individual market insurance in 2015, or 25 percent of all adult enrollees, had a declinable pre-existing condition and would not face premium surcharges under the AHCA community rating waivers if they maintain continuous coverage. 

Read the full analysis here.


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