Friday, April 28, 2017

Loss of protections for people with pre-existing conditions would disproportionately hurt states won by Trump


Before the ACA, insurance companies either denied coverage to people with pre-existing conditions or charged them more than other people for their coverage (this was only true in the individual market, not the employer-provided market). As a result, millions of Americans were unable to find affordable coverage. The ACA outlawed this practice, but the new Republican health care proposal will allow it again in most states. 

Insurers will still be required to cover everyone who can afford coverage, but they will be able to charge any price and decide which treatments to cover. (The new proposal eliminates the ACA's requirement that insurers provide ten "essential health benefits"). This will effectively end protections for people with pre-existing conditions. The Republicans claim that states will be free to choose whether they allow this, but because the the proposal will no longer require healthy people to buy insurance, most states will be forced to reinstate the practice in order to avoid unaffordable increases in insurance premiums for most of their residents. 

Kaiser Family Foundation conducted an analysis in 2016 of the percentage of people in each state who have excludable pre-existing conditions under the pre-ACA rules. I've taken that analysis and broken it down by which candidate won the presidential election in each state. As the table shows, the new rules will disproportionately effect Trump states. Of the 17 states with an above-average percentage of people with excludable conditions, 15 voted for Trump. 

Yesterday, Trump reportedly decided to keep NAFTA because his agriculture and commerce secretaries  brought him a map showing that its elimination would disproportionately hurt Trump country.  How I wish the President read this blog and also that I was better at making maps. 

By the way, GOP cuts and changes to ACA subsidies would also disproportionately hurt voters in Trump counties (mainly rural)

Percent of Non-Elderly Population with Excludable Pre-existing Conditions under pre-ACA insurance Rules* by 2016 Presidential Winner
West Virginia
36%
Trump
Mississippi
34%
Trump
Kentucky
33%
Trump
Alabama
33%
Trump
Arkansas
32%
Trump
Tennessee
32%
Trump
Oklahoma
31%
Trump
Kansas
30%
Trump
Louisiana
30%
Trump
Missouri
30%
Trump
Indiana
30%
Trump
Georgia
29%
Trump
Delaware
29%
Clinton
Maine**
29%
Clinton
South Carolina
28%
Trump
Michigan
28%
Trump
Ohio
28%
Trump
United States
27%



*Gary ClaxtonCynthia Cox, Anthony Damico, Larry Levitt, and Karen Pollitz. 2016. “Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA,” Kaiser Family Foundation Issue Brief, Dec 12. <http://kff.org/health-reform/issue-brief/pre-existing-conditions-and-medical-underwriting-in-the-individual-insurance-market-prior-to-the-aca/>


**Clinton received 3 electoral votes in Maine and Trump received 1.

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