Democrats are telling the constituents of a Pennsylvania Republican that repealing the Affordable Care Act "would take health care away from 657,000 children in Pennsylvania with preexisting conditions." No, it wouldn't.
That number comes from an Obama administration estimate for all children living in Pennsylvania, under 18, with some kind of preexisting condition. It's not an estimate of how many had gained coverage because of the law's preexisting condition protections. Or an estimate of how many would lose their insurance if the law were repealed.
The Democratic Congressional Campaign Committee is targeting House Republicans in favor of repeal with email blasts that highlight benefits of the law. It's true that the Affordable Care Act requires insurance companies to cover all children, under age 19, regardless of preexisting conditions. And the law includes the same protection for adults. But it's simply not true that 657,000 kids in Pennsylvania would lose their health care without the law.
The email criticizing Rep. Mike Fitzpatrick, who favors repeal, is headlined: "#CostsOfRepeal: Congressman Fitzpatrick's Repeal Would Take Health Care Away from 657,000 Children in Pennsylvania with Preexisting Conditions." (The emails encourage use of the Twitter hashtag#CostsOfRepeal.) The message goes on to say: "Kids with preexisting conditions like asthma and diabetes would be the latest victims of Congressman Mike Fitzpatrick's plan to repeal the Affordable Care Act, with 657,000 at risk of losing their coverage in Pennsylvania – sending us back to the days when insurance companies were free to deny coverage to sick kids, or charge them exorbitant premiums."
The National Journal printed a similar DCCC message that mentions both children being denied coverage and "129 million Americans – including 5,489,162 people in Pennsylvania" who "could be denied coverage." The 129 million figure is for all non-elderly Americans with a preexisting condition and also comes from an administration report.
Even the softer "at risk of losing their coverage" wording is inaccurate. Instead, the figures represent the high-end of Obama administration estimates of everyone with preexisting conditions — whether they are already covered with private insurance or a government program such as Medicaid, or are uninsured. If, for some reason, all of those 657,000 kids in Pennsylvania were thrown into the individual market, they could potentially be at risk of being denied coverage or charged higher premiums, without the preexisting condition protections of the ACA.
A November 2011 report from the Department of Health and Human Services estimated that as many as 17 million children nationwide had a condition that could lead to denial of coverage or higher rates on the pre-ACA individual market. That's the high-end of the administration estimate. The low estimate was 4 million, which is the number that would be eligible for high-risk pools. The HHS report adds to that children with "common conditions that major insurers generally use in medical underwriting," bringing the total to 17 million.
Of course, every child with some type of preexisting condition wasn't seeking coverage on the individual market before the ACA was passed, and they wouldn't be if it were repealed. Many had coverage on their parents' employer-based policies; others had Medicaid or Children's Health Insurance Program coverage. Employer plans wouldn't deny insurance coverage due to preexisting conditions, and HIPAA (Health Insurance Portability and Accountability Act of 1996) limits "preexisting condition exclusion" periods, when a policy could refuse coverage of a condition for a certain time period for new workers that have lacked continuous coverage.
The report acknowledged this, saying: "Generally, pre-existing conditions matter less for people insured through employers that have a large risk pool and can therefore spread the cost of workers' illnesses or injuries. In addition, some insurance protections already exist for people changing jobs."
Most Americans get coverage through an employer, and the law doesn't change that by much. The Congressional Budget Office estimates that the number of Americans with work-based plans will be 158 million in 2018 because of the law, 7 million fewer than would have been the case without the Affordable Care Act.
The administration does have a point, as we said when we wrote about this report before. Some of those with work-based jobs and a health condition may stay at their current jobs simply because of the health benefits, worried about seeking coverage elsewhere. The report notes that employees with preexisting conditions "would be vulnerable without the new law."
Sure, they could be, if they had to, or wanted to, seek coverage on the individual market. And the DCCC would be accurate to say that these hundreds of thousands of kids in Pennsylvania, and millions nationwide, enjoy added protections because of the Affordable Care Act. But repealing the law wouldn't "take health care away from 657,000 children in Pennsylvania with preexisting conditions," as the email attacking Fitzpatrick says.