How many people would be screwed over by repealing the ACA? 23 Million? 30 Million? Try 52 Million.
Posted on Thu, 12/29/2016 - 3:22pm
I've crunched the numbers up and down to come up with an estimate of how many people would likely lose their healthcare coverage entirely if the Republican Party does indeed repeal the Affordable Care Act, as they've been vowing to do for years now. My best estimate comes in at around 23 million people for a full repeal with immediate effect and no reasonable alternative in place to pick up the pieces. Meanwhile, the Urban Institute ran their own projections and concluded that nearly 30 million people would lose coverage from a partial repeal (which would actually have an even bigger negative impact than a full repeal since it would pretty much wipe out the off-exchange individual market as well via a "death spiral" domino effect).
However, there's another way of looking at this: Let's suppose that a full repeal does go through...including the much-debated requirement that insurance carriers have to accept people with pre-existing conditions into the same policies as everyone else, and that they can't be charged more for the same policies due to their medical condition. Just how many people are we talking about here?
Well, according to a Kaiser Family Foundation study published a few weeks back, the answer is "a lot":
http://acasignups.net/16/12/31/how-many-people-would-be-screwed-over-repealing-aca-23-million-30-million-try-52-million
Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA
Dec 12, 2016 | Gary Claxton, Cynthia Cox Follow @cynthiaccox on Twitter , Anthony Damico, Larry Levitt Follow @larry_levitt on Twitter , and Karen Pollitz
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Estimates of the Share of Adults with Pre-Existing Conditions
We estimate that 27% of adult Americans under the age of 65 have health conditions that would likely leave them uninsurable if they applied for individual market coverage under pre-ACA underwriting practices that existed in nearly all states. While a large share of this group has coverage through an employer or public coverage where they do not face medical underwriting, these estimates quantify how many people could be ineligible for individual market insurance under pre-ACA practices if they were to ever lose this coverage. This is a conservative estimate as these surveys do not include sufficient detail on several conditions that would have been declinable before the ACA (such as HIV/AIDS, or hepatitis C). Additionally, millions more have other conditions that could be either declinable by some insurers based on their pre-ACA underwriting guidelines or grounds for higher premiums, exclusions, or limitations under pre-ACA underwriting practices. In a separate Kaiser Family Foundation poll, most people (53%) report that they or someone in their household has a pre-existing condition.
The rates of declinable pre-existing conditions vary from state to state. On the low end, in Colorado and Minnesota, at least 22% of non-elderly adults have conditions that would likely be declinable if they were to seek coverage in the individual market under pre-ACA underwriting practices. Rates are higher in other states – particularly in the South – such as Tennessee (32%), Arkansas (32%), Alabama (33%), Kentucky (33%), Mississippi (34%), and West Virginia (36%), where at least a third of the non-elderly population would have declinable conditions.
{There follows a chart of people with pre-existing conditions broken down by state}
Discussion
The Affordable Care Act guarantees access to health insurance in the individual market and ends other underwriting practices that left many people with pre-existing conditions uninsured or with limited coverage before the law. As discussions get underway to repeal and replace the ACA, this analysis quantifies the number of adults who would be at risk of being denied if they were to seek coverage in the individual market under pre-ACA rules. What types of protections are preserved for people with pre-existing conditions will be a key element in the debate over repealing and replacing the ACA.
We estimate that at least 52 million non-elderly adult Americans (27% of those under the age of 65) have a health condition that would leave them uninsurable under medical underwriting practices used in the vast majority of state individual markets prior to the ACA. Results vary from state-to-state, with rates ranging around 22 – 23% in some Northern and Western states to 33% or more in some southern states. Our estimates are conservative and do not account for a number of conditions that were often declinable (but for which data are not available), nor do our estimates account for declinable medications, declinable occupations, and conditions that could lead to other adverse underwriting practices (such as higher premiums or exclusions).
http://kff.org/health-reform/issue-brief/pre-existing-conditions-and-medical-underwriting-in-the-individual-insurance-market-prior-to-the-aca/?utm_content=42291628&utm_medium=social&utm_source=twitter
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