Vance is proposing insurance changes that could increase premiums for the sick

Memorably, former President Trump mentioned “concepts of a plan” during last month’s presidential debate when asked about his proposal to reform health care. Now his running mate, Senator JD Vance, says there is a plan to “improve health care,” specifically regarding the Affordable Care Act.

Vance argues that the health insurance market should be deregulated. He talks about placing people with chronic conditions in separate insurance pools. But this could lead to insurers charging higher premiums for those with pre-existing conditions.

Kamala Harris’ campaign released a report yesterday saying that millions of people with pre-existing conditions could lose the protections guaranteed to them by the ACA rules if Vance’s changes go through.

During his time in office, Trump attempted to undo ACA through executive actions, legislation, and lawsuits. Yet the law persisted. And during Trump’s bid to secure a second presidential term, he has wavered on the idea of ​​repealing the ACA.

But perhaps, given that the ACA is popular and growing in terms of enrollment and the uninsured rate is at an all-time low, Trump is now calling for what he describes as improvements in the law, rather than abolishing the ACA. His running mate, Vance, is proposing substantive changes to ACA health insurance coverage that could lead to eliminating the ACA’s protections against insurers that charge higher premiums on individuals in poor health.

Vance has talked about deregulating the insurance market so that “people can choose a plan that makes sense for them,” as reported in The hill. For example, on the campaign trail in North Carolina last month, Vance proposed eliminating the ACA’s single risk pool, which allows for community assessment, and introducing separate risk pools for people with chronic health conditions. This would disrupt one of the ACA’s guiding principles, which states that health insurers should not charge people higher premiums based on their health status.

KFF estimates that 27% of adults have a condition that would have resulted in an insurer denying coverage in the individual market before the ACA. Before the law was passed, insurers could deny coverage for a wide range of diseases or charge significantly higher premiums for those with pre-existing conditions.

Vance wants to leave decisions about how to regulate what insurers do with the aforementioned high-risk insurance pools up to individual states. If certain states then allow premium surcharges based on health status, people with pre-existing conditions would theoretically have access to health insurance, but it could be unaffordable.

High-risk state pools could provide access to coverage to people with pre-existing conditions as an alternative to the private insurance market. But whether such pools would be effective would depend on adequate funding, which did not happen in the states that established them before the ACA went into effect. And so, for many, these insurance pools were not a viable option due to exorbitant premiums.

About the stump, Vance also said, “we’re going to actually implement regulatory reform in the health care system, allowing people to choose a health care plan that works for them. If you only go to the doctor once a year, you need a different care plan than someone who goes to the doctor fourteen times a year because they have chronic pain or another chronic condition.”

While it’s unclear what Vance has in mind for healthier individuals in particular, he may be referring to short-term insurance plans that the Trump administration has promoted and made more accessible. These options do not provide as comprehensive coverage as ACA plans. Some healthy people may have an incentive to opt for short-term insurance, which can be renewed every three to 12 months, as a way to reduce premiums.

The problem is that this can significantly drive up costs for the sicker people who remain on ACA exchange plans. Furthermore, the idea of ​​offering healthy individuals a cheaper plan with much less comprehensive coverage tacitly assumes that people’s health needs are static, which is often not the case. Perhaps the most important purpose of having health insurance is to provide financial protection against cancer unforeseen events. The fact that someone visits a doctor only once now has no impact on the future, whether that is next year or later.

Only 39% of respondents surveyed by KFF in February of this year were aware that the ACA prohibits insurers from denying coverage to people with pre-existing conditions, and only 31% knew that the ACA also prevents sick people from experiencing higher premiums are charged than healthy individuals. In light of Vance’s statements on ACA reform, it seems important that the electorate be better informed about what the proposed changes might entail.