Does the Affordable Care Act end health discrimination for kids before 2014? Washington Post (blog)
A lot of folks have asked why the Affordable Care Act only eliminates preexisting condition discrimination in 2014. The basic answer is that in order to avoid an insurance death spiral, where costs rise because sick people rush into the system and healthy people rush out, you need to pair the end of health discrimination with a couple of other policies: The major pieces are guaranteed issue, so insurers also have to sell insurance to everyone; an individual mandate, so the risk pool includes both the healthy and the sick; and subsidies, so it's affordable for people to buy insurance.
But one of the bill's immediate benefits was that it ended health discrimination for children. I figured it could do that quickly because children aren't very expensive to insure, and most of the kids who would be affected -- that is to say, kids who aren't covered by insurance their parents get from employers -- are eligible for S-CHIP. That may still be true, but it also appears that there was less to this policy than met the eye: It gets rid of health discrimination, but it doesn't impose guaranteed issue. That is to say, an insurer can't charge high prices to a kid with a congenital heart defect, but the insurer can deny the kid coverage altogether. At least until 2014.



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