Pre-Existing Condition? Your Insurance Could Cost Up to $140,000 More Under the AHCA

May 05, 2017

Insurance premiums for people with pre-existing conditions could increase by hundreds of thousands of dollars if the American Health Care Act, which passed the House Thursday, becomes law in its current form.

The AHCA allows insurers in states that offer a high-risk pool option to charge people with pre-existing conditions more for insurance if the patients do not maintain continuous coverage. This insurance underwriting practice is currently banned by the Affordable Care Act, and is one of the health law's most popular provisions.

But if the Senate keeps the waiver provision of the AHCA, cancer patients could see premium surcharges as high as $142,650, according to a report from the liberal Center for American Progress.

The CAP report estimates premium surcharges for conditions for a 40-year old with various ailments compared to a healthy 40-year-old, based on data from the Centers for Medicare and Medicaid Services. The surcharge is compared to an assumed $4,020 standard rate for healthy individuals.

The study finds that "individuals with even relatively mild pre-existing conditions would pay thousands of dollars above standard rates to obtain coverage." For example, someone with asthma would experience a premium surcharge of $4,340, while someone who suffers from diabetes would face a $5,600-per-year increase. For those with serious medical conditions, the costs are exorbitantly higher.

Here are some of the other surcharges, based on CAP's report:

ConditionSurcharge as a share of standard premiumSurcharge in dollars
Metastatic cancer3,500%$142,650
Lung, brain, and other severe cancers1,790%$72,980
Colorectal, breast, kidney, and other cancers703%$28,660
Diabetes without complication137%$5,600
Rheumatoid arthritis and specified autoimmune disorders652%$26,580
Major depressive and bipolar disorders208%$8,490
Drug dependence502%$20,450
Autistic Disorder135%$5,510
Seizure disorders and convulsions179%$7,300
Congestive heart failure459%$18,720
Asthma106%$4,340
Stage 4 chronic kidney disease286%$11,650
Completed pregnancy with no or minor complications425%$17,320

It's important to note that the AHCA still bans basing premiums on gender and occupation, so pregnancy may not be considered a pre-existing condition, though that is unclear.

CAP's estimates are based on national data, so they would vary by state. But the underlying message remains: If the ACA's protections for people with pre-existing conditions are scrapped in the GOP's health bill, sick people in the individual market will pay much, much more for health insurance.

A separate report from the AARP found premiums in the high-risk insurance pools could exceed $25,000.

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