Obamacare Repeal: What Happens to People With Pre-Existing Conditions?

One of the Affordable Care Act's most popular features is the one that blocks insurers from discriminating against people with pre-existing conditions. Insurers can't deny them coverage, can't limit coverage, and can't charge them more. It's a dramatic change from the pre-Obamacare era, when insurers could deny coverage to people with medical histories that include diabetes, high blood pressure, or even pregnancy.

Crucially, this provision applies to all Americans, not just though who purchase insurance through Obamacare exchanges. So what happens to this popular provision if the Senate repeals Obamacare?

Right now, it's not clear. Currently, Republicans only have enough votes to repeal parts of Obamacare via budget reconciliation. That means they can only attack parts of the law that involve a cost to the government, by stripping away associated funding. If the GOP successfully does this, as they intend, the pre-existing conditions provision would not be touched, and would basically stay in effect—until they manage to pass a replacement plan.

President-elect Donald Trump has said he would like to keep the provision. But Republicans haven't presented a unified replacement plan, so it's impossible to say with certainty what will happen. Cynthia Cox, associate director of the non-profit Kaiser Family Foundation, says a "continuous coverage" policy seems likely, and is included in House Speaker Paul Ryan's "A Better Way" plan.

In effect, under a "continuous coverage" policy, a person with a pre-existing condition would need to avoid having any gap in insurance coverage in order to avoid paying more for insurance or being denied outright. So if you lose your job and your health coverage, insurers would be able to deny you coverage. But if you never have a gap, then you can't be discriminated against.

Cox advises people to ensure they have coverage right now, because if this continuous coverage policy is implemented, it's unclear when people would need to be insured to qualify. It's also unclear how continuous coverage would be defined and whether there might be any flexibility. Can you go a month without insurance and still not be discriminated against for having a pre-existing condition? Three months?

In that light, purchasing a bare-bones policy could make sense. Some Republican plans promote "skimpy" insurance options, Cox says, which don't cost a lot but have tons of coverage exclusions. But they would be an option so people could have continuous coverage in the event that they are laid off from their job or can't afford a better plan.

“It’s never good to have a gap in coverage," says Larry Levitt, senior vice president of the Kaiser Family Foundation. "But if these replacement plans pass, it could be catastrophic.”