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I vividly remember my mom saying over the phone "thanks President Obama" while we talked about how relieved we were that I had health insurance again. I was standing at the bus stop on my college campus, feeling a weight lifted off my shoulders now that I had health coverage thanks to the Affordable Care Act's (ACA) protections for people with pre-existing conditions. For the six years prior to that, I was involuntarily riding a rollercoaster as a teenager with Type 1 diabetes in a country that allowed health insurance companies to discriminate against people with pre-existing conditions. At the time, my parents were both self-employed meaning that I was denied health insurance from the individual market because I had the bad luck to be over 18 years old and living with a chronic illness.
The Republican candidates for president and vice president want to return to a time when people with pre-existing conditions and chronic diseases were legally discriminated against by health insurance companies. Sen. J.D. Vance (R-OH) has recently described this arcane policy as separating people with chronic illness into "high-risk pools." What he does not say is that these high-risk pools will come with higher health insurance premiums for sicker people, often up to twice as much as a healthy person would pay. These plans will also have high deductibles, meaning sick people will pay thousands of dollars out-of-pocket before their coverage kicks in. If former President Donald Trump and Vance get to implement more of their "deregulatory" health agenda, these high-risk plans could get even worse by having lifetime limits on the medical care a person can get and excluding coverage for the sick person's pre-existing condition for the first year of insurance. Though this plan would allow people with pre-existing conditions to still have health "coverage" that coverage would be paper thin and prohibitively expensive.
To see what that kind of future would look like we don't need a crystal ball, we can simply look back to what life was like before the ACA. For me, it was using any extra money I had from student loans to pay close to $1,000 each month for the insulin I needed to stay alive. It was using that insulin longer than prescribed, risking infection, because I couldn't afford to waste a drop of it. It was not going to the doctor as often as needed because I feared medical bills piling up. In this return to the past, there would be huge increases in medical debt held by Americans, which is already $220 billion. Even worse, discriminating against people with chronic illness would lead to poorer outcomes, including preventable complications and death. For me and the 129 million Americans living with a chronic illness, this would be the reality if Trump and Vance succeed in their plan to deregulate the insurance market and allow division of people with chronic conditions into separate health plans.
In contrast to the detrimental effect of the Trump health care agenda for people needing care, these changes would be a gift to private health insurance companies. These companies fully embrace the idea of deregulating insurance plans as they continue to take in enormous amounts of cash. Just last year, the seven largest for-profit insurers made $1.39 trillion in revenue. By removing protective regulations requiring insurers not to charge higher premiums based on health status, these companies could increase their revenue and profits by price-gouging sick people. If the new high-risk pools become federal or state-run, insurance companies will avoid having to pay for the medical care that sicker people need, again increasing their profits. The health care agenda laid out by Trump and Vance is not meant to benefit everyday Americans, it is meant to benefit Insurance companies.
Our current health care system is not perfect, it is a work in progress. There is more to do to ensure that everyone has coverage, to lower out-of-pocket costs, and to stop insurance companies from denying needed care. But we cannot move backwards. Moving back to a system where it was acceptable to charge someone more or deny them care because of their health status would put the health of over 100 million Americans in danger and potentially throw them off of their health plans. We cannot go back, we must not go back to that system. We are not going back.
Rachel Madley is director of policy and advocacy at the Center for Health and Democracy.
The views expressed in this article are the writer's own.
