Here’s why pre-existing conditions are such a sticking point in the health-care debate


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House Republicans are pushing for a vote Thursday on a bill to repeal and replace Obamacare, even as questions linger about whether it has enough support to pass.

One issue in the sticking point in the debate has been protections for patients with pre-existing conditions. Prior to the passage of the Affordable Care Act, patients with prior illness could be excluded from coverage or charged higher premiums, even if those health issues had already been resolved.

Momentum behind the Republican repeal effort began in earnest Wednesday after two leading Republicans, Reps. Billy Long and Fred Upton, agreed to switch their expected “no” votes on the bill to “yes” votes.

The change of heart began after the Republican bill, the American Health Care Act, was amended to provide $8 billion in federal funding that would supposedly protect such customers from higher premiums.

It is difficult to know the impact of this amendment as well as prior ones because the nonpartisan Congressional Budget Office has not had time to analyze the legislation.

The Center for American Progress, a progressive think tank in Washington, published an analysis last month, prior to recent amendments, that break down the impact the AHCA could have on patients who have even relatively mild pre-existing conditions.

Based on their analysis, those people would pay thousands of dollars above the standard rates to receive health-care coverage.

The following table shows the impact various ailments would have on the premiums an average 40-year-old would pay. These surcharges range from about $4,340 for a patient with asthma to as much as $142,650 for a patient with metastatic cancer.

At the time of the analysis, there was discussion of a Federal Invisible Risk Sharing Program that would establish a $15 billion fund to help offset insurers’ expenses for patients with high-cost health conditions, similar to the reinsurance program created under Obamacare.

The group looked at how that program was structured and estimated it could reduce overall premiums by between 1 percent and 2 percent. The third column of the charge shows the premium with a 1.5 percent reduction for the risk pool factored into it.

While Republicans are eager to make good on their campaign promise to repeal and replace Obamacare, they will need to tread carefully with the final result.

A Wall Street Journal article wrote about a study conducted by the Kaiser Family Foundation that used government data to estimate the number of adults in any given state that would have been unable to buy insurance in the individual insurance market prior to the ACA. This would be patients with a history of severe pre-existing conditions.

That study suggests that states with the largest shares of people with pre-existing conditions, at that time, resided in states that voted for Donald Trump for president last November.

What’s interesting is based on the Wall Street Journal’s analysis at that time, many of the House members who support the proposed health law come from states with the largest populations of people with pre-existing conditions.

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