Health and Science

GOP's Obamacare replacement bill would protect just 5 percent of people with pre-existing conditions: Analysis

Key Points
  • The Republican bill would potentially allow insurers to charge sick people higher premiums.
  • To offset those costs, the bill also allocates funding for financial aid for sicker people.
  • High-risk pools in states before Obamacare tended not to cover enough people.
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The Republican bill to repeal and replace Obamacare does not allocate nearly enough money to protect people with pre-existing health conditions from potentially higher insurance premiums, an analysis finds.

The bill's $23 billion in funding specifically for such people would cover just 110,000 Americans, according to the Avalere Health study released Thursday.

That's only 5 percent of the 2.2 million current enrollees in the individual insurance market with some type of pre-existing chronic condition.

And even if states were to add in all the other money in the bill's $100 billion Patient and State Stability Fund, only a total of 600,000 people with pre-exisiting conditions could be covered, the study found.

Avalere said the gap between funding and need could leave many people with health problems unable to afford insurance coverage if the GOP's American Health Care Act becomes law.

"Texas alone has approximately 190,000 enrollees in its individual market with pre-existing chronic conditions, nearly 80,000 more people than the funds earmarked for the entire country would cover," Avalere said. "Florida has 205,000, nearly 95,000 more than the funds allotted nationally ... would cover."

The study was released hours before the House was expected to vote on the Republican bill. That vote was successful and the bill now will head to the Senate for consideration.

That bill would allow states to obtain waivers for insurers that would let those companies charge sicker people more money for coverage than healthier people if they let their insurance plans lapse, as long as the state creates a program to give those sicker people financial aid for their coverage.

To offset some of the cost of those higher charges, the bill also sets aside funding to subsidize coverage for people with pre-existing conditions through high-risk pools in individual states.

But Obamacare defenders have said that past efforts by states that ran high-risk pools for such people have failed to cover enough people, and did not have adequate funding.

Avalere's analysis suggests that history could repeat itself if the Republican bill becomes law.

"Given the amount of funding in the bill, the program can only afford a few small states to opt into medical underwriting," said Caroline Pearson, senior vice president at Avalere. Medical underwriting is the practice of determining health insurance rates based on an individual customer's health status.

"If any large states receive a waiver, many chronically ill individuals could be left without access to insurance," Pearson said.

Rep. Ileana Ros-Lehtinen, R-Fla., on Thursday blasted the bill being pushed by her own party, citing the effect on her constituents in the Sunshine State who have pre-existing conditions.

"Despite amendments and changes, the AHCA still fails to provide for the needs of my constituents," said Ros-Lehtinen, who is retiring, in a statement. "I will not support a bill that has the potential to severely harm the health and lives of people in South Florida and therefore I remain steadfast in my commitment to vote NO on the AHCA."

"The recent addition of further funds to high-risk pools continues to be inadequate and fails to cover those who need it most," she said. "If enacted, the older and poorer South Floridians will be worse off and will find it more difficult to obtain quality health care. My constituents should not have to take a step backward in their ability to obtain treatment for any illness and thus, I will vote NO."

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