Rollback of pre-existing conditions protections would affect 102 million people

More than 100 million individuals would be impacted by rollbacks in protections for those with pre-existing conditions mandated under the Affordable Care Act, according to consulting firm Avalere Health.

More than 50 percent of Americans, or 102 million people, enrolled in coverage outside public programs such as Medicare and Medicaid, would be at risk of medical underwriting or denial of health insurance coverage without the ACA, Avalere found.

The high figure comes at a time when healthcare has become a top voting issue in the upcoming November midterm elections. Republicans, who attempted to overturn the ACA multiple times in 2017, have changed their tune in the lead-up to the midterms, as protections for pre-existing conditions are one of the most popular elements of the healthcare law.

The Trump administration also recently issued a new guidance that would allow states to offer more flexibility to sell short-term limited-duration health plans that typically do not cover pre-existing conditions and do not have to follow ACA requirements.

Other attempts to strip away the ACA and its provisions are still underway. A lawsuit is currently pending judgement that could overturn the ACA, and the Trump administration has decided not to defend key provisions in the case, including covering people with pre-existing conditions. That lawsuit will likely not be settled before the midterm elections.

“Virtually every American has someone with an existing health condition in their family at any given time,” Dan Mendelson, founder of Avalere, said in a statement. “This is why Americans are so concerned with the issue, and why they expect durable, bipartisan solutions that maintain and strengthen healthcare security.”

Cost of conditions

Outside the individual markets, Americans enrolled in a health insurance plan through their employer could also face risks of higher costs as a result of a pre-existing condition, or be denied coverage altogether. Individuals with pre-existing conditions returning to a pre-ACA high-risk pool in 2019 could see premiums as high as $25,700 per year, according to an AARP projection from 2017.

Another practice that could return is a year-long waiting period where employers can refuse to cover pre-existing conditions if employees fail to maintain continuous coverage, Avalere warned. Of the 203.6 million lives in the non-Medicare and non-Medicaid populations in 2015, 102.4 million had a pre-existing condition, such as cardiovascular disease, a mental health disorder or obesity.

“Protections for pre-existing conditions are the only reason some Americans are able to afford health insurance,” Chris Sloan, director at Avalere, said in the analysis. “Many of the most common health conditions in the country could lead to individuals being denied access to health insurance if pre-existing condition protections are eliminated.” 

To conduct its analysis, Avalere looked at data from the 2015 Medical Expenditures Panel Survey.