Dismantling the Affordable Care Act Leaves Millions Vulnerable

The State-by-State Prevalence of Asthma, Diabetes, and High Blood Pressure

Source: Centers for Disease Control and Prevention, “Behavioral Risk Factor Surveillance System Survey Data” (2009).
Note: Some states have “guaranteed issue” statutes that prevent insurers from denying coverage on the basis of pre-existing conditions.

This week, Congress will consider the continuing resolution for funding federal agencies, including those responsible for implementing the Affordable Care Act. Paragraph by paragraph, opponents of the new law will be able to offer amendments to the bill—and they intend to offer amendments that will strip health reform of key funding.

This is especially problematic for those who suffer from chronic conditions such as asthma, diabetes, and high blood pressure. These chronic diseases affect millions of Americans across the country. Full implementation of the Affordable Care Act will help these individuals receive the insurance coverage they need, and it will lower their health costs in the process. But full implementation relies on full funding.

A recent study, conducted by the Department of Health and Human Resources, estimates that up to one in two Americans under age 65—129 million individuals—could be denied coverage or face higher costs if the Affordable Care Act is not fully implemented. Without health reform implementation, these individuals can do little to stop insurance companies from denying or limiting coverage based on any combination of health status, age, and gender. Not surprisingly, one in five nonelderly Americans with a “pre-existing condition”—25 million individuals—is uninsured.

Many insurers refuse to cover Americans with such conditions so the Affordable Care Act bans this discriminatory practice. Current law provides these Americans with new rights and protections, which will prevent insurance companies from refusing to issue coverage or otherwise discriminating against older, sicker individuals, as well as women. Yet opponents of current law are trying to undermine these new gains by defunding these reforms.

The above map shows state-by-state numbers and prevalence rates of adults who have a history of asthma, diabetes, or high blood pressure—three conditions insurance companies have used to limit or flat out deny coverage. Implementation of the Affordable Care Act has already eliminated lifetime fixed dollar coverage limits. It has prohibited insurers from denying coverage to children with pre-existing conditions. Thousands of Americans have enrolled in the Pre-existing Condition Insurance plan, a high-risk pool program for the uninsured.

And there’s still work to do. When the new law is fully implemented in 2014, insurers will no longer be able to determine eligibility, benefits, or premiums based on health status. Also in 2014, individuals and small businesses will benefit from competitive marketplaces, or exchanges, to purchase the low-cost, high-value plans that cover an essential set of benefits.

None of these new, nondiscriminatory policies will be effective, however, if Congress refuses to fund the work it takes to get them started. So far, opponents of the new reform law have proposed a series of amendments to strip funding from the federal agencies that are working to implement the Affordable Care Act. If approved, here’s what some of them would do:

• Refuse to pay the salaries of federal employees who work on health insurance exchanges. Exchanges will make high-value, competitive health plans available to vulnerable groups.
• Refuse to pay the salaries of federal employees who work on overseeing insurance companies and protecting consumers. Much of their work focuses on protecting Americans from unfair health insurance practices.
• Refuse to pay salaries for any federal worker who is tasked with implementing the minimum-coverage requirement—the new requirement that all individuals carry health insurance. Without this provision, premiums will increase, on average, 27 percent for individuals who purchase coverage, including people with chronic illnesses.

Nearly a third of all American adults have high blood pressure, as the map indicates. Asthma affects up to one-fifth of the adult population and diabetes affects up to one-tenth of adults. These individuals might not obtain the affordable, stable coverage they need without full implementation of the Affordable Care Act. They might remain uninsured or remain with a particular employer to maintain their existing health coverage.

Health reform provides new security and stability for Americans with chronic illnesses. The Affordable Care Act protects all Americans from bad insurance company practices, ensures coverage is affordable regardless of health status, and strives to stabilize the rise in health care costs by ensuring that both healthy and sick people have coverage.

Isabel Perera is Special Assistant for Health Policy at the Center for American Progress. This piece is based on previous work by Sonia Sekhar, who was formerly a Research Assistant at the Center.