Insurers Can't Deny Coverage Under AHCA, But They Can Do This

by Joseph D. Lyons
Pool/Getty Images News/Getty Images

Obamacare's days may be numbered after all. The Republicans finally came together last week to pass an even more conservative "repeal and replace" plan than initially submitted in the House. Of course the Senate still has to work out their own version and reconcile it with the House before the bill heads to the president's desk. But it's clear what the framework will be, including a clause in the American Health Care Act that allows states to opt out of the pre-existing condition clause of Obamacare. So does the AHCA allow insurers to deny coverage? No, but coverage could cost a lot more.

Evidently, some have taken attacks on the bill to mean that they could be denied coverage altogether based on their existing health problems. Even the GOP is worried about the optics on that one, and Paul Ryan took to ABC's Sunday politics show, This Week to talk over the matter with George Stephanopoulos.

"Under this bill, no matter what, you cannot be denied coverage if you have a pre-existing condition," Ryan said on the show. But he glosses over what happens if you have a gap in coverage, say from a bout of unemployment. That could cost a pretty penny in the new plan.

In the states that opt to obtain waivers for the pre-existing condition rules from Obamacare, health insurance will surely skyrocket for the sick and the formerly sick. The Center for American Progress ran some numbers and released a report on the issue that shows what certain pre-existing conditions would cost, and the numbers are scary. The national average surcharge for an asthma diagnosis would be $4,270. Breast cancer could run about $28,230 extra. Even pregnancy would have an added cost of $17,060.

The supposed solution in the bill is a GOP idea called high-risk pools. They would lump all the sick people together in order to bring down insurance rates for healthy people. But of course, those sick people's insurance would cost a fortune. There's funding included in the bill to offset those costs, but some skeptics argue it will be far from enough and there will either be waiting lists or rates that are unaffordable despite subsidies.

But Ryan's suggested path to affordable insurance would be to keep the one you have now. "You can't charge people more if they keep continuous coverage," Ryan told Stephanopoulos, who rightly pointed out that most people who lose their insurance do not do so on purpose. Ryan doesn't see it that way, though. For him it's like "waiting until your house is on fire to then buy your homeowner's insurance." That doesn't take into consideration job loss or other life issues that could stop you from paying your premium.

What's funny is what Ryan said next. "You want to make sure that people stay covered to keep the cost down," he told Stephanopoulos. Sure, just as long as you don't make people stay covered or provide them with subsidies to do so. Unfortunately, those with pre-existing conditions are likely going to need way more financial help going forward.