Study: 6M with pre-existing conditions could be charged more under GOP plan

Study: 6M with pre-existing conditions could be charged more under GOP plan
© Greg Nash

More than 6 million people with pre-existing conditions could face higher insurance premiums under the GOP’s ObamaCare repeal bill because of gaps in coverage, according to a new analysis by the Kaiser Family Foundation (KFF).

Under the American Health Care Act (AHCA), which narrowly passed the House last month, states would be allowed to waive the community rating provision of ObamaCare, which prevents insurers from charging more for those with pre-existing conditions. 

The provision was added in the final days before the bill's passage to win conservative votes. Conservatives argue that the provision won't affect many people, because it only targets enrollees who have had a gap in insurance of at least 63 consecutive days.


But according to the analysis released Wednesday, 6.3 million people who have a pre-existing condition also have had gaps in coverage that would lead to a substantial premium increase. Since the legislation keeps ObamaCare's ban on insurers denying coverage based on pre-existing conditions, those people would instead be charged a lot more money.

More 27 million people had a gap in coverage of at least several months in 2015, the analysis said.

Karen Pollitz, a KFF senior fellow and one of the study's authors, told The Hill that while the 63-day rule may seem like a long time, "unless you act almost immediately [after losing coverage] you could end up with a 63-day gap.”

The AHCA provides $100 billion to all states for a variety of purposes, including high-risk pools, reinsurance programs and cost-sharing subsidies. States can't get a waiver unless they have a high-risk pool or a reinsurance program. 

But only a high-risk pool can help people who were priced out of coverage because of a pre-existing condition, and there's no requirement that states need to set up such an alternative source of coverage, Pollitz said.

The Senate is currently working behind closed doors on its own version of ObamaCare repeal, and it's not clear if the provision will remain.