Members with Pre-Existing Conditions May Be Impacted by ACA Debate

October 07, 2019 - If the Affordable Care Act (ACA) was not in effect in 2018, 45 percent of families would have one non-elderly adult with a pre-existing condition for which they might be declined from healthcare coverage, an updated Kaiser Family Foundation report found.

This most recent study builds on similar data from 2016 which found that revoking ACA would lead to significant coverage barriers. In this most recent study, researchers used data from Centers for Disease Control (CDC) to construct a picture of declinability based on age, health status, and declinable conditions.

“While most people with pre-existing conditions are covered now through employers or public programs such as Medicaid, people may look to the individual market for coverage during periods of transition, such as losing or changing a job, leaving a job due to illness, starting a business, aging off a parent’s policy, retiring before age 65, or losing Medicaid eligibility,” the researchers wrote.

“Before the ACA protections took effect in 2014, private insurers in the individual market could use applicants’ health status, history and other risk factors to determine whether and under what terms to issue coverage.”

While the results and the inquiries were largely the same for the number of individuals who could be declined, observing the potential impact on families was a new factor introduced this year.

The study found that approximately 45 percent of families included a non-elderly adult who suffered a declinable, pre-existing condition.

Like in 2016, the study found that 27 percent, or 53.8 million individuals, suffered from conditions that could be declinable in pre-ACA era. Such pre-existing conditions include AIDS, congenital heart failure, and diabetes, which affects more than 100 million Americans according to the CDC.

Also similar to the 2016 statistics, women continue to face higher rates of declinable pre-existing conditions than men—30 percent to 24 percent. However, the 2018 report clarified, pregnancy accounts for approximately 6.6 percent of women’s declinability.

The older individuals are, the more likely they would be to be declined, the researchers also concluded. The bulk of declinable individuals are in the 55 to 64 age range, where 44 percent of individuals could be declined for healthcare coverage based on their health. The prevalence of declinable, pre-existing conditions decreases sharply from there.

The results varied state-by-state, but rarely diverted from 2016 levels. The highest increases and decreases were no more than three percentage points in either direction. At 22 percent, Coloradans still have the lowest likelihood of being declined based on their condition, whereas over a third of the populations in Arkansas, Kentucky, Mississippi, and West Virginia could be denied coverage under pre-ACA standards.

These potential consequences of revoking the ACA prove relevant as the Fifth Circuit Court of Appeals considers the law’s constitutionality.

In the recent past, KFF and other research organizations have released reports expounding on the potential consequences of a repealed ACA and the benefits of retaining it.

Another KFF report, for example, found that the ACA’s Medicaid expansions led to better coverage, greater access to care, higher quality of care, and economic improvement.

The National Bureau of Economic Research also found that Medicaid expansions under the ACA decreased Medicaid mortality rates due to higher enrollment and coverage.

Despite these benefits, the ACA continues to face numerous challenges both inside and outside of the court room.

Only recently have the federal health insurance marketplaces seen significant improvement in coverage and plan options across counties. Particularly in 2018, many counties still faced the potential reality of being a bare county with just one health payer in the region.

And while the ACA expansions may have led to improvement in some areas of the economy, lack of legal action against the ACA’s health insurance tax portends a 2.2 percent rise in premiums in 2020.

While experts can weigh the benefits and consequences of repealing the ACA, unpredictable political maneuvering, such as a seemingly impossible bipartisan ACA replacement and election year rhetoric, would also factor into the ultimate impact, making a potential future without the ACA uncertain.