Jayne O'Donnell

USA TODAY

About one in six people who are sick or have suffered from chronic health conditions will pay more for health insurance that covers less under the House-passed legislation to replace the Affordable Care Act — if they’re able to get insurance at all, the Congressional Budget Office concluded in a new report on the bill.

The budget office estimated how many states would take the American Health Care Act's option to waive two key provisions of the ACA: The prohibition on charging people more if they have preexisting conditions and the requirement to cover "essential health benefits" including maternity and mental health care.

It's a difficult to predict how many states will do so, says health care economist Craig Garthwaite, but conservative states will be the ones most likely to opt out of ACA requirements.That means the AHCA passed with the waiver options and he had, say, cancer in remission and paid for his own insurance, Garthwaite says he'd be worried.

"I’d be moving to California, Massachusetts or my home state of Connecticut," says Garthwaite, an associate professor and director of the health care program at Northwestern University's Kellogg School of Management.

CBO said premiums set based on where people live would rise over time and people who are less healthy or have pre-existing conditions in certain areas "would ultimately be unable" to buy insurance that covers the level of benefits now required at prices that are comparable to today.

High-risk pools won't help

The money allocated for high-risk pools in the AHCA — which experts say would cover less than 15% of care for the sickest patients — won’t help either.

The insurance markets in the areas where these people live would become “unstable," which is what House Republicans and the Trump administration say is happening under the ACA.

"The experience in states that choose to spend less on their sickest citizens is really big financial burdens for the patients and their families, including bankruptcy," says Adams Dudley, a physician and director of the Center for Healthcare Value at the University of California, San Francisco.

Another problem with designing insurance so people who are sick pay more is that "it's not just people with preexisting conditions; it's people who don't know disaster is about to happen," says Dudley.

Those people may choose "skimpy plans," says Dudley, and wind up with massive medical debt.

Garthwaite says "nothing has infuriated me more" than the talk about how states that accept the option of covering fewer benefits will have lower premiums.

"You get less and pay less," he says. "People shouldn’t think of that as a good economic coverage, especially if you lose the option of paying more to get more."

Donald Kirkendall, an Orlando, Fla., insurance broker says he's fine with that, even if he doesn't think the AHCA is the answer. He calls the legislation "putting lipstick on a pig."

Read more:

CBO: House Obamacare repeal will increase uninsured by 23 million

Experts: Pre-existing coverage in House GOP bill would fall far short

What health insurance covers could change dramatically if AHCA becomes law

His insurance premiums have tripled to more than $750 a month since the ACA went into effect and he's particularly miffed about having insurance with maternity coverage.

If insurers are allowed to compete based on what benefits they offer, though, many won't offer generous plans and consumers "can’t buy a plan an insurer isn’t offering," says Garthwaite.

"The nice thing about the ACA standardizing the benefit package is it's perhaps the only way to make sure people can have access to relatively broad coverage," he says.

In Baton Rouge, insurance broker Ronnell Nolan says the biggest complaint she hears is about sky-high premiums. But she also worries about removing too many of the consumer protections

Before the health law passed, she says "if a doctor even looked at your knee," you might not be able to get health insurance.

"How far do they go back to before the ACA?" she asks.

What's your healthcare experience? Tell us at healthinsurance@usatoday.com