How A Lawsuit Challenging Obamacare Could Affect People With Pre-Existing Conditions

NPR's Ailsa Chang talks with Sabrina Corlette from Georgetown University's Center on Health Insurance Reforms about how a lawsuit against Obamacare could impact people with pre-existing conditions.

AILSA CHANG, HOST:

One of the central goals of the Affordable Care Act is to protect people with pre-existing conditions. That means insurers have to cover sick people. The Trump administration announced earlier this week that it supports a federal lawsuit challenging the existence of the ACA. Wiping out the health care law could mean that people with pre-existing conditions won't be able to get coverage or will have to pay more for insurance.

To talk about all this, we're joined now by Sabrina Corlette. She's a professor at the Center on Health Insurance Reforms at Georgetown University. Welcome.

SABRINA CORLETTE: Thank you.

CHANG: So we throw around this phrase a lot - pre-existing conditions - when we're talking about health care. Can you just first lay out exactly what is a pre-existing condition?

CORLETTE: Well, that can be very much in the eye of the insurance company. In fact, before the Affordable Care Act, many companies maintained lists of up to 400 different conditions that might cause somebody to be denied a policy or to be charged more. And that could range from serious conditions like HIV, AIDS, hemophilia, cancer or could be fairly minor - asthma, glaucoma...

CHANG: Glaucoma.

CORLETTE: (Laughter) Exactly. All of those things could trigger what was called underwriting, where they would screen somebody out or carve out the treatment that you might need to treat that condition and not pay for it.

CHANG: And where did this idea of the pre-existing condition come from in the first place?

CORLETTE: Well, most insurance companies, their business model is based on avoiding risk. They worry that people will wait until they're sick to sign up for coverage. So to protect themselves from that, they came up with a variety of tools that allow them to screen out people who might cost them money. And that includes denying policies.

It includes charging a higher premium than they would a healthy person. It could mean that they don't cover certain parts of the benefit package. For example, if you had a history of asthma, they might say, well, we'll cover you but nothing having to do with an upper respiratory condition.

CHANG: Right. But it sounds like what you're saying is, this concept of the pre-existing condition, it's an invention by the insurance industry. This is not some medical term from the medical profession. This is an insurance-invented word or idea.

CORLETTE: That's absolutely right.

CHANG: So in a way, though, insurers have a point. It is more expensive to cover someone who has an illness.

CORLETTE: Yes, that's right. And they do worry that, without certain protections in place, people will not buy coverage when they're healthy and then, you know, when they're in the ambulance on the way to the hospital, they'll call up the insurance company and say, please sign me up for a policy. And if that happens, then the system just doesn't work because premiums will be too expensive and unaffordable for everybody else.

CHANG: OK. But even if the Trump administration is successful in ending the Affordable Care Act in the courts, is it politically possible at this point to completely take away protection for pre-existing conditions because it's popular among voters in both parties?

CORLETTE: Right. So if the court rules in favor of the Trump administration, these protections will be gone at the federal level. And so Congress would have to step in and restore them. Unfortunately, we have a pretty divided House and Senate, and it's hard to imagine them coming to agreement. That said, interestingly, the number of states have stepped up to try to enact these protections at the state level.

But there are limits. For example, states are not allowed to pass laws that affect people with employer-based insurance. That's really a federal responsibility. So states can protect people in the individual market - folks who are buying on their own. But for most of us in employer-based plans, that really would need a federal law change.

CHANG: Sabrina Corlette is a lawyer and professor at Georgetown's Center on Health Insurance Reforms. Thanks so much for coming into the studio today.

CORLETTE: Thank you.

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