What happens to ACA-acquired insurance if the ACA gets repealed?
November 5, 2013 12:06 PM   Subscribe

Without getting into the politics or likelihood of it all, I was wondering what happens to insurance policies acquired through the ACA if the ACA somehow gets repealed? Are those people (who might have pre-existing conditions, etc) going to be left without insurance?

A personal example is my spouse, who has cancer, but is "fortunate" enough to have private insurance, which offers good coverage with an exorbitant premium. She has this insurance because she was covered through this PPO when she was a student and diagnosed, and has been told by the insurance company that she can keep the policy as long as she keeps making the premium payments. These have gotten so high that we can surely save quite a bit of money by getting a policy via the ACA, but now we're worried about what might happen if it gets modified or repealed? We'd be dropping the ultra-expensive sure-thing policy for the possibility of saving money.

I'm assuming that if the ACA is no longer around in its current form, that her pre-existing condition will prevent her from getting a new policy.

Perhaps I have a fundamental misunderstanding of how the ACA works, so can anyone shed some light?
posted by theplatypus to Health & Fitness (5 answers total) 3 users marked this as a favorite
In a world where that was a legitimate concern, yes, she would probably be excluded from any coverage for her cancer under a new policy even if she had continuity of care (ie, hadn't let her insurance lapse for 60 days) but two things come to mind: 1) she's been protected from rescission under the affordable care act since 2010 and 2) the only thing that was keeping her covered before that was the benevolence of management at her PPO. There was nothing stopping them from not renewing her policy simply because she was costing them too much.

That being said, I think it's extremely unlikely we'll ever see repeal to the extent that you're envisioning if only because there's going to be millions of people in the same position as your spouse, and they make really good campaign commercials.
posted by Oktober at 12:23 PM on November 5, 2013 [5 favorites]

No, your understanding is correct. In the scenario that ACA is repealed, and her policy would likely not be renewed, though it would stand through the original term.

However, even before ACA, congress passed a law that stated a group policy could not disqualify and individual with a pre-existing condition if they had continuous coverage. This doesn't help you in the scenario that ACA is repealed, and you're back on the individual market.

I know you said you didn't want to get into the politics/probabilities of it all, but when push comes to shove, most politicians would not repeal the popular parts of the law, like the pre-existing conditions clause. You really, really, really can't let these kinds of fears govern your future actions. You clearly have enough to worry about. Make the rational choice of today.
posted by fontophilic at 12:26 PM on November 5, 2013 [7 favorites]

What is the likelihood that your spouse will become part of a group plan at any point in the near future? Most people get on a group plan through an employer but my husband is a part of my group plan through my employer. The deal with group plans is that the risk and cost is spread out across the group so in theory, the insurance company can't reject an individual - they're part of the group. That doesn't have anything to do with ACA so I imagine it would remain the case if ACA was repealed.

Not to be a jerk but where is your fear that the ACA will be repealed coming from? I ask because that sounds like the kind of thing a jerk insurer would say so they could continue charging you a lot of money. I concur with fontophilic. When the general public is surveyed on the individual parts of ACA - people with pre-existing conditions cannot be denied coverage, no lifetime caps, children can stay on their parents' insurance until age 26 - they are overwhelmingly supportive.

One of the things that preceded ACA was the birth of high-risk pools which were supposed to help people like your spouse who would be potentially screwed on the open market. They're not Cadillac plans but the idea was that the state would step in and make sure that people with pre-existing conditions could afford bare bones insurance. But again, making it so that insurance companies could no longer screw over people with pre-existing conditions is one of the most popular parts of the ACA so if the law was repealed, I think it would be replaced with something including that provision.

Im just a rando on the internet. I won't be there to help you out if shit hits the fan, ACA gets repealed, Jesus comes back and is grouchy, etc. Crazy shit happens all the time and I am not always right. But. The likelihood of ACA being repealed, in my opinion, is on par with the likelihood that I get a job working in the White House - I guess it could happen, it's not impossible, but it's really unlikely.
posted by kat518 at 2:40 PM on November 5, 2013 [1 favorite]

Response by poster: Thanks all - to follow-up on a few points:

- She's not working right now, and is applying for disability (a whole other can of worms) because she's suffering from some cognitive deficits from her treatment (brain tumor, seems that digging around, radiating, then chemo-ing the brain is um... disruptive). So really, she's at zero income, but we're keeping her insurance to ensure that she gets the highest level of care possible, without compromise.
- In a pinch, I could get her covered under my work insurance, but we really don't want my job to feel like they need get rid of me because I'm driving up premiums (feels like something they'd do), plus I'm looking to change jobs soon.
- I agree that it's unlikely to be repealed. It would be difficult, if not impossible to take away benefits like these from your average American once they have them, as kat518 pointed out. I suppose it might just end up with us weighing the cost savings against feeling like we're staring down the barrel of bankruptcy should she lose her insurance. The fear that the ACA will be repealed? I don't put anything past our politicians these days. Trusting our future with insurance companies and politicians is a heckuva minefield.

Thanks for your input, everyone. I've floated a few topics here before where I've felt like I needed some perspective because things were too close to home/I was in too-deep, and you all have always come through with thoughtful input.
posted by theplatypus at 8:07 PM on November 5, 2013

Not that they might not try, but it would be a pretty serious ERISA (and ADA, probably) problem for your company to fire you because of the health claims of your spouse as a beneficiary under a group health plan (assuming it's an ERISA plan, not a church or government plan).
posted by Pax at 10:30 AM on November 6, 2013

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