Glied Sherry, Jackson Adlan
Robert F. Wagner School of Public Service, New York University.
Issue Brief (Commonw Fund). 2017 Jun;18:1-12.
Prior to the Affordable Care Act (ACA), people with preexisting health conditions could be denied insurance coverage or charged higher rates. If the law is repealed, these protections could be diluted or lost altogether. GOALS: Assess the ACA's impact on coverage and access for people with preexisting conditions and compare their coverage gains with state high-risk-pool enrollment pre-ACA. METHODS: Analysis of Behavioral Risk Factor Surveillance System data for the period 2011–13 to 2015. KEY FINDINGS AND CONCLUSIONS: Between 2013 and 2015, 16.5 million nonelderly adults gained coverage following full ACA implementation. Of those, 2.6 million had preexisting conditions that could have otherwise precluded them from coverage because of discriminatory denials and pricing; 9.4 million had conditions that could have otherwise affected insurance cost. We found strong correlations between these coverage gains and access to care. Coverage and access gains for people with preexisting conditions were unrelated to the size or existence of the state high-risk pools that 35 states funded for such individuals pre-ACA. Our findings suggest that proposals to replace current protections for people with preexisting conditions with high-risk pools are unlikely to be sufficient to maintain the ACA's gains.
在《平价医疗法案》（ACA）出台之前，已有健康问题的人可能会被拒绝承保或被收取更高的费率。如果该法律被废除，这些保护措施可能会被削弱或完全丧失。目标：评估ACA对已有健康问题人群的保险覆盖范围和就医机会的影响，并将他们获得的保险覆盖范围与ACA实施前各州高风险保险池的参保情况进行比较。方法：分析2011 - 13年至2015年期间的行为风险因素监测系统数据。主要发现与结论：在2013年至2015年期间，随着ACA全面实施，1650万非老年成年人获得了保险覆盖。其中，260万人存在已有健康问题，否则可能因歧视性拒保和定价而无法获得保险覆盖；940万人的健康问题可能会影响保险费用。我们发现这些保险覆盖范围的增加与就医机会之间存在很强的相关性。已有健康问题人群的保险覆盖范围和就医机会的增加与35个州在ACA实施前为这些人设立的高风险保险池的规模或存在与否无关。我们的研究结果表明，用高风险保险池取代目前对已有健康问题人群的保护措施的提议不太可能足以维持ACA所取得的成果。
