Would Health Insurers Embrace Underwriting Again?

Since at least the 2017 saga when Republicans tried to repeal and replace the Affordable Care Act (ACA), one of the law’s most visible — and politically charged — components has become its protections for people with preexisting conditions. Now, with the makeup of the Supreme Court slated to shift, some experts believe those same provisions are the most at risk from being struck down alongside the law’s now-defunct individual mandate (see story, p. 1).

But that begs the question: Would health insurers actually want to go back to a pre-ACA world?

“No, they so do not want that to happen,” says Chris Sloan, an associate principal at Avalere Health. Before the ACA was enacted, “it wasn’t that they [insurers] liked medically underwriting — they didn’t like the bad press, they didn’t like that sort of perception of their industry — it’s just that anybody who didn’t would get all the bad risk and their health plan would collapse,” Sloan explains.

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Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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