AHCA would cover only 5% of Americans with pre-existing conditions: report

And premiums would rise higher than $140,000 a year for people with certain illnesses.
Paul Ryan
Paul Ryan. (Photo: Getty Images)

Although the Congressional Budget Office hasn't yet scored the version of the American Health Care Act that passed the House on Thursday — meaning that no one knows exactly how much the Obamacare replacement plan would cost overall, or how many would lose health insurance under it — the potential costs to individuals are becoming clearer.

 

The plan passed after Rep. Fred Upton of Michigan, an early holdout, had $8 billion added to the bill's "high-risk pools" intended to help cover people with pre-existing conditions. That brought the total set aside to $23 billion.

 

But an analysis by Avalere Health found that the American Health Care Act would only cover 5% of people with pre-existing conditions. More than 2.2 million Americans have some type of pre-existing condition, and $23 billion would provide coverage for only 110,000 of them.

 

RELATED: What does the AHCA consider a pre-existing condition?

 

"Texas alone has approximately 190,000 enrollees in its individual market with pre-existing chronic conditions, nearly 80,000 more people than the funds earmarked for the entire country would cover," said Avalere.

Last weekend, Donald Trump said the American Health Care Act "guaranteed" coverage to those with pre-existing conditions, but CNN pointed out that it was unclear whether he knew what he was talking about. House speaker Paul Ryan said the American Health Care Act "protects people with pre-existing conditions." The New York Times found those assertions "misleading" because the AHCA does not protect them from higher costs.

The Center for American Progress estimated how much annual health-insurance premiums would rise for a 40-year-old with certain pre-existing conditions. They included the 1.5% discount a high-risk pool would provide. A sample of what they found (costs are per year):

  • Asthma: $4,270

  • Autism: $5,420

  • Diabetes: $5,510

  • Drug dependence: $20,450

  • Pregnancy: $17,060

  • Rheumatoid arthritis and specified autoimmune disorders: $26,180

  • Colorectal, breast, kidney, and other cancers: $28,230

  • Lung, brain, and other severe cancers: $71,880

  • Metastatic cancer: $140,510


A CBO score is expected next week. The AHCA now heads to the Senate.