When it was legal, health insurers collected information on demographic characteristics and medical history and often denied coverage. One survey found that one-third of individual market applicants were charged rates that were higher than the standard based on their personal characteristics or medical history. Meanwhile, another survey, released in 2009, found that more than one-third of patients were denied coverage, had exclusions placed on their policy due to pre-existing conditions, or were charged more, as the HHS brief noted.
The nonpartisan Kaiser Family Foundation estimated recently that 27 percent of non-Medicare-aged U.S. adults have one or more pre-existing conditions that would likely render them uninsurable if we went back to the medical underwriting practices that existed in states prior to the ACA.
Another key market reform that should be maintained is helping young adults secure insurance coverage through their parents’ health plans to age 26. The HHS reports that between 2010 and October 2013 a whopping 2.3 million young adults aged 19 to 25 gained health insurance under the ACA provision that allows people under the age of 26 to stay on a parent’s plan, leading to a decline in the uninsured rate for young adults from 34.1 percent to 26.7 percent in that period. Another 3.8 million young adults gained coverage between October 2013 and early 2016, with 13.9 percent of young adults remaining uninsured. The AMA has policy that supports making coverage available through parents’ plans to age 28, and believes the accessibility up to age 26 should at least be maintained.
Last, but certainly not least, there should be no lifetime cap on health insurance benefits. The value and security provided by health insurance should not be diminished by limiting coverage across a patient’s life span in those cases where they have a costly disease or condition.
The ACA is imperfect. There are serious concerns about the stability of the individual insurance market and the choice of health plans available under the law. But as policymakers move ahead with considering a replacement, they should not lose sight of the real advances in access to coverage that have been made, affecting millions of Americans.
Read more about the AMA's comprehensive vision for health-system reform, refined over more than two decades by the AMA’s House of Delegates, which is composed of representatives of more than 190 state and national specialty medical associations.