Going Up?

Doctor_patientUp, up and away. That made for a great line in a classic song, but it’s not the tune you want to hear when talking about the cost of health care premiums. Unfortuately, a new report by the Kaiser Family Foundation found that 6.3 million people with pre-existing conditions may see their premiums soar higher under the House’s version of the American Health Care Act (AHCA).

From FierceHealthcare.com:

Kaiser_AHCAUnder an amendment included in the American Health Care Act, 6.3 million people with pre-existing conditions could see a spike in their health insurance premiums, a new analysis estimated.

The MacArthur-Meadows amendment, it noted, allows insurers in states that opt for the waiver to vary individual market premiums based on health status for an entire plan year for people who had a gap in coverage of 63 straight days or more in the past year.

In 2015, there were a total of 27.4 million of those individuals, the analysis found. Of that total, 23%, or 6.3 million, had pre-existing conditions that would lead them to face a “substantial premium surcharge” if they live in a state that chooses to waive the community rating rule.

CNN.com added, “Under Obamacare, insurers can no longer charge consumers based on their medical histories. The House GOP bill, which was approved and moved to the Senate two weeks ago, would let states jettison that popular provision for people who have a gap in coverage.”

If that 63-day gap seems like a long time to be without coverage, TheHill.com spoke to one of the study’s authors, Karen Pollitz, who said 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 Fiscal Times pointed out it will be difficult to determine the accuracy of the Kaiser study, but added the key may be whether states, like Arizona, pursue the pre-existing condition waiver.

The measurement of the bill’s impact is admittedly uncertain. While it is clear that the threat of higher premiums creates an incentive for people to maintain continuous coverage, the authors write, “The question is how many would be able to do so, given the fact that the premium tax credits provided for in the AHCA would be 36 percent lower on average for marketplace enrollees than under the ACA and would grow more slowly over time.”

In the end, the biggest wildcard is how many states would choose to accept the AHCA’s waivers, the study concludes. “What states decide to do may ultimately have the greatest effect on how many people with pre-existing conditions face potentially unaffordable insurance premiums.”

The Arizona Hospital and Healthcare Association (AzHHA) will continue to encourage our state’s congressional delegation to make sure the final healthcare bill that is signed into law best serves the people, patients and communities of Arizona. Working together to make sure that happens will help us take another big step forward in our goal to one day make Arizona the Healthiest State in the Nation!

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