Loss of Consumer Protections Could Return Healthcare Coverage to Pre-ACA Days

As the Trump administration looks to make radical changes in the way that healthcare is delivered, a new report suggests that eliminating current consumer protections will make it more difficult for families and children to obtain affordable coverage.

President Trump and congressional Republicans are considering replacements for the Affordable Care Act that would reduce the protections against pre-existing condition exclusions and allow insurers to charge more for older enrollees. This would drive conditions back to the pre-ACA days when most Americans could not buy coverage on the individual market, according to a new Commonwealth Fund report.

Prior to the passage of the Affordable Care Act, the individual insurance market was a notoriously difficult place for consumers without employer-based health benefits to purchase insurance. It also was challenging for insurers to sell insurance without incurring large losses. As a result, insurers went to great lengths to exclude people with even mild health problems. In 2010, the Commonwealth Fund Biennial Health Insurance Survey found that more than one-third of people who tried to purchase health insurance in the individual market in the previous three years—an estimated 9 million people—had been turned down, charged a higher price, or had a condition excluded from their health plan.

By January 2016, near the end of the ACA’s fourth open-enrollment period, things had changed. The size of the individual market has nearly doubled since 2010.  As a result of changes that have made purchasing and affording coverage easier—and with consumer protections such as bans against insurers charging people more or denying coverage because of preexisting conditions—nearly 9 million people have signed up for a plan through HealthCare.gov, the federal marketplace website. This does not include enrollment in 11 states plus the District of Columbia that operate their own marketplaces. An additional 7 million are estimated to have purchased coverage in the individual market outside the marketplaces, where insurers must comply with the same regulations as the ACA. Further, more than 16 million people have enrolled in Medicaid and the Children’s Health Insurance Program. All told, more than 30 million people are currently insured as a result of the ACA’s insurance subsidies, expanded Medicaid eligibility, state and federal outreach efforts, and market regulations.

Members of Congress and the Trump administration are currently pursuing repeal of certain provisions of the ACA. The number of uninsured U.S. adults ages 19 to 64 declined to 23 million, or 12% of the population, in July to November 2016 from a high of 37 million, or 20%, in 2010.

Continuous Coverage

An estimated 18 million adults, or 10%, were insured at the time of the survey but had gaps in their insurance coverage in the past 12 months—about the same as in years prior to the ACA. About 147 million adults, or 78%, were insured continuously in 2016, up from a low of 70%, or 129 million, in 2012. If Congress removes preexisting condition protections for those who have coverage gaps, those 18 consumers could be prevented from ever obtaining affordable coverage.


  • In 2012, 80 million adults said they went without health care or medication they needed because of the cost, compared to 63 million in 2016.
  • In 2010, more than two of five (43%) adults buying plans on their own said they found it difficult or impossible to find a plan that fit their needs, compared to one-quarter (25%) in 2016.
  • In 2010, more than half (53%) of adults with health problems said it was difficult or impossible to find a plan that fit their needs; this fell to one-third (31%) in 2016. For people with low incomes, the share reporting such difficulty fell by about half, from 49% in 2010 to 26% in 2016.
  • In 2012, 29% said they did not go to a doctor when they were sick because of the cost, compared to 20% in 2016. In 2012 over one-quarter of adults (27%) said they did not fill a prescription because of the cost, compared to one-fifth (19%) in 2016.
  • In 2016, the share of adults reporting they had skipped a recommended test, treatment, or follow-up visit because of the cost fell to 18%, from 27% in 2012. And in 2016, 13% said they had not gotten needed care from a specialist because of the cost, down from 20% in 2012.

“Before the Affordable Care Act, it was often extremely hard for people not covered through an employer to buy coverage,” said Sara Collins, vice president for Health Care Coverage and Access at the Commonwealth Fund and the report’s lead author.

“Many were routinely turned down, told a preexisting condition would not be covered, or charged higher rates because of an illness,” Collins said. “This survey finds that since the law was passed the individual market has changed dramatically. Now, millions of people are finding and buying affordable plans that provide coverage meeting their needs.”

Info: https://goo.gl/liKuOw (report).

About Frank Klimko

Frank Klimko is a nationally known journalist, grants expert and speech writer/speaker. He has years of experience helping nonprofits devise lists of the right funding opportunities and secure funding from these foundations and corporate entities. Clients have focused on an array of areas including child care, homeless, hunger and K-12 education. Additionally, he is a Freedom of Information Act expert, who has helped numerous clients with securing proprietary information from the federal government. Currently, Frank Klimko writes the Children & Youth Funding Report and Private Grants Alert, which are Washington DC-based publications. CYF is a daily publication covering Congress, the Education Dept. and the various federal regulatory agencies. PGA, another daily publication, covers the world of private philanthropy.
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