Patients With Pre-Existing Conditions at Risk If Obamacare Struck Down

If the Supreme Court strikes down the Affordable Care Act, one group is certain to feel the impact acutely: people with pre-existing conditions.

Patients with pre-existing coverage struggled to get coverage prior to the advent of the ACA, as insurance companies tried to avoid taking on patients who would be likely to cost more than they would pay in premiums. The new law requires all Americans to have coverage, and also requires insurance companies to take all comers. It also provides for subsidies for people who cannot afford coverage. During the period leading up to the law’s full implementation, a national insurance pool has been created as a bridge for people with pre-existing conditions.

All of those provisions are imperiled, however, by the case currently before the Supreme Court. While it is unclear whether the court will strike down the entire law, or even part of the law, the part of the law requiring coverage for people with pre-existing conditions is the most at risk.

Those people include patients like Eric Richter, whose story was highlighted in a New York Times article:

The tumor grew like a thick vine up the back of Eric Richter’s leg, reminding him every time he sat down that he was a man without insurance. In April, when it was close to bursting through his skin, he went to the emergency room. Doctors told him it was malignant and urged surgery.

His wife called every major insurance company she found on the Internet, but none would cover him: His cancer was a pre-existing condition. In desperation, the Richters agreed to pay half their hospital bill, knowing they could never afford it on their combined salaries of $36,000 a year.

If the Affordable Care Act had been in place, insurance companies would have been required to cover Richter, and he would have his premiums capped at $285 a month, with tax credits covering anything over that.

While the ACA has not been fully implemented, there is at least one option available for patients with pre-existing conditions. The Pre-Existing Conditions Insurance Plan, or PCIP, offers insurance for those who do not get insurance through work, and who do not qualify for Medicaid. While patients must be without insurance for six months before qualifying for PCIP, it offers an option for coverage for people who would not otherwise be covered. The plan is designed to phase out once the ACA mandates begin in 2014.

But the PCIP was created by the ACA. Like other provisions, its continued existence is in doubt if the entire law is struck down.

If the ACA is struck down in whole or in part, Democrats and President Barack Obama have said they will try to repair the damage. Republican presidential candidate Mitt Romney has said that he would support some limited extension of care for people with pre-existing conditions, but only for people who had previously had insurance.

Democrats have been hopeful that if the Supreme Court acts, it will only strike down the mandate and requirement of coverage for pre-existing care. There are provisions in the law that would certainly benefit a number of Americans — subsidies for coverage, requirements for large companies to cover employees, and provisions allowing young adults to remain on their parents’ insurance through age 26. But for people with pre-existing conditions, those provisions may not mean much; if insurance companies do not need to take people who are already ill, all the subsidies in the world won’t help them.

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Image Credit: Paul Barker, Stock.Xchng


julie b.
julie brush5 years ago

Dr. c. I love everything you are hit thy nail on the head everytime....Thank you. It's refreshing to see someone is informed,doesn't drink the kool-aid,doesn't even like kool-aid!

Carole R.
Carole R5 years ago

Everyone needs and deserves good healthcare.
How can any society just let people die because they can't afford decent healthcare?

Beth K.
.5 years ago

I meant that if a pregnant woman is not insured, and tries to get insurance for the birth, they will tell her is is pre-existing, and probably not cover it.

Beth K.
.5 years ago

Do you know that most insurance companies consider pregnancy a pre-existing condition?

Diana Bair
Diana Bair5 years ago

What is wrong with our country that there are so many uncaring selfish people here. this is NOT the americian.........WAY!!!!!!!!. idiots that do not care about others. Calling hard working people...lazy just because they are poor and don't have as much as they do. wanting to elect some creep as president, Romney. our country is so full of hate and greed, then these phonies pretend to be good ............CHRISTIAN PEOPLE..........They are phonies, they have never read the bible they are NOT .......CHRISTLIKE, Jesus would NEVER treat poor as these phonies do. ONE LADY GOES WHY SHOULD HER TAXES FEED POOR, LAZY PEOPLE "THEY ARE NOT LAZY"!!!!!!!!, POOR DOES NOT MEAN LAZY. THESE IS A GREEDY MEAN SPIRITED PERSON, That does not have all the facts!!!!!!. she needs to get her FACTS straight!!!!!!!. as do a lot of other greedis......out there, there are poor, and the BIBLE even clearly says POOR WILL ALWAYS BE .......HERE, and they do the best they ....CAN. Diana.

Susan Williams
Susan Williams5 years ago

For profit and employer related healthcare system is wrong on every level.

Angela N.
Angela N5 years ago

thanks :)

Catt R.
Catt R5 years ago

David F.... the first 'nurses' were Nuns who had taken an oath of poverty..... health care should be about taking care of the sick, aged, and infirm...... NOT about creating wealth and leaving to suffer and die those who do not have the means to enrich the health care system---- health care should not be something that is only available to the rich

Dr Clue
Dr Clue5 years ago

Since that event where the republican's peeps on wall-street made their financial killing winning their bet that America would fail (using their stacked deck) ,we've not herd much about those fantastic plans the republicans were selling for addressing medical care and retirement.

Perhaps folks are of short memory there , so let me paraphrase there plan...

Take your money and "invest" it in medical and retirement plans based upon playing the ponies in that same market on wall-street. Imagine where your healthcare and retirement would be today had they managed to sell that cow too!

Can your hear that sound of laughter , can you smell that cigar smoke?

Dr Clue
Dr Clue5 years ago

In my youth I had an occasion to need medical care, but back then we had the county hospital.
The building was old , the walls devoid of fancy art and decoration and much of the equipment antique, but despite that , the actual medicare was top shelf.

Given the choice between a slickly decorated corporate medical system with pricey marketing, lobbyists along with care centered on profits OR that weary old county hospital focused on getting the medical job done and not stock dividends , I'll take the county hospital every time.