Obamacare fact check: Vance's promise to cover people with pre-existing conditions

CNN
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Republican vice presidential nominee Sen. JD Vance has attempted to provide some details about the “concepts” of a health care plan that former President Donald Trump mentioned in the September presidential debate.

In an interview on NBC's “Meet the Press” the following week, Vance said Trump's plan was “actually quite simple.”

“You want to make sure that pre-existing coverages – medical conditions – are covered, you want to make sure people have access to the doctors they need, and you also want to implement a deregulation agenda so people can choose a health insurance plan. “suits them,” Vance told the show's host, Kristen Welker.

“We want to make sure everyone is covered,” he continued. “But the best way to do that is to actually promote more choice in our health care system and not take a one-size-fits-all approach that puts a lot of people into the same insurance pools, into the same risk pools. This actually makes it harder for people to make the right decisions for their families.”

Facts first: Vance's claim that pre-existing conditions would be covered if insurers didn't have to group people into the same risk pools is misleading and needs context. A key pillar of the Affordable Care Act's comprehensive protections for people with pre-existing conditions is that insurers must include all of their individual market participants in the same risk pool.
This is crucial to ensure that insurers do not charge higher premiums to people with chronic conditions, which could leave many of them unable to afford coverage.

Obamacare's protections for people with pre-existing conditions is one of the most popular provisions – about two-thirds of the public say it is “very important” to maintain the law's provisions that prohibit insurers from charging sick people more and restricting coverage based on their medical records to refuse. according to a February KFF survey.

But like many Republicans before him, Vance says the way to improve the country's health insurance system is to move away from the Affordable Care Act's plethora of regulations and give people more choices. Republicans in Congress expressed similar sentiments in their 2017 attempt to repeal the landmark law, which failed in part because of concerns that their replacement plans would weaken protections for people with pre-existing conditions.

One example that Vance gave in the NBC interview and that he repeated at a rally in North Carolina a few days later is allowing insurers to separate people into different risk pools. While placing healthy people in a risk pool would most likely lower their premiums, doing the same to sick consumers would almost certainly cause their premiums to skyrocket.

With a single risk pool, “there are some people who are healthier, and they end up subsidizing those who are less healthy,” Sabrina Corlette, co-director of Georgetown University's Center on Health Insurance Reforms, told CNN.

Creating high-risk pools for the chronically ill has been tried before and largely failed, despite being subsidized by states and sometimes federal grants. Before the Affordable Care Act, 35 states operated such pools — which Corlette called “expensive, poor-quality ghettos” in a recent blog post. In 2011, they insured more than 226,000 people – far fewer than were eligible – and caused a total of more than $1.2 billion in losses. Despite public subsidies, rates and deductibles are high and coverage is limited in most states, Corlette said.

Vance did not mention providing federal support for at-risk pools for sick Americans, Corlette noted.

“Without a major change in government, it’s hard to imagine that people with pre-existing conditions won’t be worse off,” she said, adding that if they had to pay more, “I would call that no protection.”

Vance's campaign did not respond to a request for comment. The Harris campaign released a report Monday accusing Trump and Vance of wanting to roll back high-risk pools “that drive up costs for people who need health care most.”

Let's further explain why Obamacare provides protections for people with pre-existing conditions Such a big deal. Before the Affordable Care Act, insurers offering coverage in the individual market often asked enrollees detailed questions about their medical history. In many states, people with pre-existing conditions could be turned away or only receive limited policies that exclude coverage for their conditions. For example, someone with asthma may not have insurance coverage for upper respiratory care. And even if the medical problem had occurred years earlier and been fully resolved, consumers could have difficulty obtaining insurance.

In addition, chronically ill people often have to pay significantly higher premiums to take out insurance policies.

According to a 2019 KFF analysis, nearly 54 million Americans had pre-existing conditions that would likely make it impossible for them to receive individual coverage without Obamacare's protections.

The Affordable Care Act has changed the situation for people with pre-existing conditions. In addition to prohibiting insurers from rejecting applicants or charging them higher fees based on their health conditions, the law required carriers to offer a range of essential health benefits – including mental health, pregnancy and prescription drug coverage – based on Individual markets often lacked guidelines.

However, these regulations also resulted in higher premiums and more comprehensive insurance coverage for healthier Americans, not all of whom may want to receive all the services they need. That has led Vance and other Republicans to push for more choice in the country's health care system.