The AHCA doesn't actually define (or limit) pre-existing conditions that states can opt out of. The list below was gleaned from lists of pre-existing conditions used before the ACA was passed to exclude folk from getting insurance, shuffling them into a (limited space, high-premium) high risk pool, jacking up premiums out of the affordable range, placing arbitrary caps on annual care, etc.
Up to a quarter to a third of the non-elderly population can be tagged with one of these.
Now, nothing in the AHCA says that states must allow insurance companies to treat folk with pre-existing conditions as profit centers or pariahs, only that they can. And some almost certainly will (under the GOP banner of FREEDOM! and the like).
And, as, +John E. Bredehoft notes[1], employers, too, will be under significant economic and shareholder pressure to reduce insurance costs by throwing these folk under the bus. And as the Brookings Institution has analyzed the AHCA[2], any states dropping this protection (FREEDOM!) means that employees in all states are suddenly at risk.
But, hey, the GOP House is raising beers and congratulating themselves for finally getting something passed. Just remember that in a year in a half.
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[1] https://plus.google.com/u/0/+JohnEBredehoft/posts/JscPBC5Vfxi
[2] https://www.brookings.edu/2017/05/02/allowing-states-to-define-essential-health-benefits-could-weaken-aca-protections-against-catastrophic-costs-for-people-with-employer-coverage-nationwide/
Originally shared by +Marla Caldwell:
Here's a list of "declinable conditions" from an insurance company prior to the ACA. It serves as an approximation of what conditions or situations may cause people to be declined for coverage under the AHCA, if it becomes law.
According to health think tank the Kaiser Family Foundation, between one quarter (1/4) and one third (1/3) of the non-elderly residents of each state have declinable conditions¹. Also according to the KFF, about 52 million Americans have such conditions². The number commonly suggested today as those who may be losing insurance was 24 million. That may be a gross underestimate.
I'm concerned that the whole hue and cry over millions without insurance is going to mask what will actually happen. A gradual and insidious, hard to measure, and nearly always happening to "someone else" decline in health care. Liberals will be accused of crying wolf, and we'll go back to a declining level of health.
From that list I have 3. What's the point of health insurance if it's so easy to be disqualified?
+Vashti T To make money (in our for-profit health insurance model).
The problem is that insurance, as a concept, involves shared risk to cover extraordinary expenses (a ship sinking, a house burning down, a car being totaled). In that model, people who engage in extraordinarily risky behavior (having a history of ships sinking, having shake shingles on the roof, having a bad traffic record) can be charged much more (because of the higher risk) or excluded from the risk pool.
Health care insurance, on the other hand, is now essentially the gateway to affording any health care (except, for the moment, for extremely expensive acute care at an ER). That puts insurance companies in a bind (and consumers, and politicians, etc.): excluding high risk people (people with pre-existing conditions, for example) means those people simply can't get health care aside from a bottle of aspirin. But keeping them in the pool means it's hard for the for-profit insurance companies to make any money without raising everyone's rates.
That's why a single-payer model makes so much more sense. We already pay taxes. This would be just more taxes. What was included/excluded could be publicly debated, but the direct sense of "I'm healthy, so why am I paying for you're higher risk pre-condition?" would be removed. The biggest failing of the ACA (though probably the only way it could have been passed) was that it tried to leverage the for-profit health insurance industry as the insurance providers, paid for by individuals (on exchanges) and employers (another weird thing in the US model). Better to have done to a "Medicare for All" or a single-payer model and make the system that much more efficient (and treat the national risk pool as a national spending item).
Our health insurance in .nl is also for-profit, though the past few years they've used their reserves to keep premiums lower.
Some insurers do refuse new customers who have preexisting conditions, but that's only for the extra insurance, they cannot refuse customers the basic mandatory insurance.
Single payer would be preferable to this imo though.