The Myth of Pre-Existing Conditions

By Betsy McCaughey

December 28, 2016 5 min read

Democrats are warning that once Obamacare is repealed, people with serious illnesses won't get health insurance. President Obama says repeal will mean going "back to discriminating against Americans with pre-existing conditions." That's fake news.

The truth is, every Republican plan to repeal and replace the Affordable Care Act protects people with pre-existing conditions.

At the same time, the GOP proposals will rectify Obamacare's insidious discrimination against healthy people. Obamacare forces the healthy to pay the same premiums as the chronically ill, whose medical costs are 10 times as high, on average. It's an unavoidable fact that 5 percent of the population consumes half the nation's health care.

To see how the GOP approach would work, look to Alaska, a state that seized the initiative when healthy consumers rebelled against the cost of their Obamacare plans.

In Alaska, the burden of caring for 500 chronically ill patients was making Obamacare unaffordable for all 23,000 Alaskans in the individual market. They were facing 40 percent premium hikes for 2017. To halt the crisis, in June state authorities created a separate "high-risk" pool for the sickest people, with the cost shouldered by all Alaska taxpayers, instead of being thrust on buyers in the individual insurance market. As a result, premiums hikes were kept to single digits for 2017.

It's a microcosm of what congressional Republicans propose for all 50 states.

High-risk pools are not a new idea. Before Obamacare, about 250,000 people a year were denied coverage for health reasons by the major health insurers, and nearly all of them enrolled in high-risk pools in the 35 states that offered them. (Sadly, New York wasn't one of them, a major reason premiums were so high here.)

The ACA established a temporary high-risk pool for people not being served by the state pools in 2010, to help out until the Obamacare exchanges opened. That transitional federal risk pool enrolled another 135,000.

So, in all, as many as 500,000 people across the nation would likely need high-risk pool coverage if Obamacare is repealed.

Subsidizing high-risk pools in all 50 states would cost about $16 billion yearly. That figure assumes a per person cost of $32,000 — the same as in the federal transitional risk pool.

Congress, take note. Some Republican proposals in Congress only provide for $1 or $2 billion a year for state risk pools. That's chicken scratch. $16 billion may sound like a fortune, but it's less than half the $43 billion spent on Obamacare plan subsidies last year. And it's money far better spent, because it directly helps the sickest among us.

Separate risk pools for the medically needy will stop premiums for skyrocketing in the individual market. Voila! Healthy people will be able to buy coverage at prices that reflect their own expected health needs.

So much for the fake news that repealing Obamacare will victimize millions with pre-existing conditions. In fact, in a recent New England Journal of Medicine article, Obamacare architect Jonathan Gruber analyzed what provisions of the health law boosted coverage. The lion's share of the newly covered are on Medicaid, and the rest gained coverage thanks to Obamacare subsidies. What about Obamacare's ban on insurers considering pre-existing conditions? His article didn't show it made any difference.

In short, almost everyone with pre-existing conditions got covered before Obamacare.

In all likelihood, they'll have better insurance after repeal. Most Obamacare plans severely limit choice of hospitals and doctors, excluding specialty hospitals like Memorial Sloan-Kettering Cancer Center in New York City. For a cancer patient, being forced to change health plans and oncologists is a life or death issue.

Though Congress is divided, Democrats and Republicans should find common ground in reviving and fully funding high-risk pools. They're an honest way to subsidize care for the sick. Obamacare used devious methods, spending billions on P.R. to convince the young and healthy to overpay for insurance. Most Americans weren't fooled.

Betsy McCaughey is chairman of the Committee to Reduce Infection Deaths. To find out more about Betsy McCaughey and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at

Like it? Share it!

  • 0

Betsy McCaughey
About Betsy McCaughey
Read More | RSS | Subscribe