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    Four things to know: Payers’ biggest ACA repeal concerns




    If the ACA is repealed, health insurers wonder if they will still be required to cover individuals with pre-existing medical conditions.

    “Will these people be taken care of through high-risk pools, sponsored by the state or the federal government instead of the insurers that subsidize them now through higher premiums?” asks Mark Rust, managing partner of Barnes & Thornburg LLP and immediate past chair of the firm’s national Healthcare Department.

    “President Obama thought the ACA offered a good solution by requiring everyone to purchase health insurance, and then everyone without an employer-sponsored or a government health plan would be in one big insurance pool under the private exchanges,” Rust explains. “But while most high-risk individuals entered the pools, a much smaller percentage of healthy people did, and many others in the young population didn’t—even though the law requires it. This ended up being quite costly for insurers and taxpayers.”

    “If insurers aren’t required to cover people with pre-existing conditions, the new administration will have to come up with an alternative plan to get them insurance coverage,” Rust says. “If it doesn’t, it would be a disaster both practically and politically.”

    Practically, a large number (potentially 20%) of the 13 million people on the public exchange would not be able to get coverage, Rust surmises. Politically, the "guaranteed issue" component of the ACA was one of its most popular features on a bipartisan basis: Polls showed that more than 90% of the entire voting public believed this was a valued and important feature of the new law.



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