• Home
  • Latest
  • Fortune 500
  • Finance
  • Tech
  • Leadership
  • Lifestyle
  • Rankings
  • Multimedia

Trendingnow

1

Egg companies made $1.22 billion in profit off a $6 carton — now they’re buying their way out of a price-fixing case with 53 million donated eggs

2

Even as Elon Musk calls philanthropy ‘very hard,’ everyday Americans gave a record $617 billion—despite feeling the squeeze over the cost of living

3

Meet the Zillennials: The luckiest micro-generation in the workforce, born between 1993 and 1998

1

Egg companies made $1.22 billion in profit off a $6 carton — now they’re buying their way out of a price-fixing case with 53 million donated eggs

2

Even as Elon Musk calls philanthropy ‘very hard,’ everyday Americans gave a record $617 billion—despite feeling the squeeze over the cost of living

3

Meet the Zillennials: The luckiest micro-generation in the workforce, born between 1993 and 1998
Commentary

Obamacare Architect: Repeal Bill Is Still a Nightmare for Those With Preexisting Conditions

By
Jonathan Gruber
Jonathan Gruber
Down Arrow Button Icon
By
Jonathan Gruber
Jonathan Gruber
Down Arrow Button Icon
May 4, 2017, 11:50 AM ET
Video Poster
Add Fortune on Google for similar content.

The recent debate over repealing and replacing the Affordable Care Act, more commonly known as Obamacare, has centered on the question of protecting Americans who have preexisting conditions. Republicans’ new bill, which is on the verge of passing the House of Representatives on Thursday, strips away those protections.

Even though the GOP’s latest proposal adds $8 billion to cover people with preexisting conditions, it won’t be enough to guarantee coverage for all Americans. Furthermore, in order to win the votes of the most conservative members of the House, this law would allow states to opt out of these vital insurance protections, returning the U.S. to the bad old days of insurer-led discrimination.

For most Americans, this is an irrelevant concern. They have employer- or government-provided insurance. Under this system, Americans, their employers, and the government all pay in, and in return they are covered if they get sick. They don’t have to explain where an illness came from: If they are sick, they get the health care they need.

But before 2014, for the roughly 70 million Americans without such coverage, it wasn’t that simple. If they got sick, the insurer got to decide if their illness was the result of something wrong with them before they bought insurance. If the insurer decided this was the case, they didn’t have to cover treatment.

And insurance companies were very good at finding reasons why this might be the case. For example, Sarah Kliff at Vox writes about the case of a woman in Tennessee whose house was infested with Asian beetles. Unbeknownst to her, she had a debilitating allergy to these beetles. But when she went to the doctor for treatment, the insurance company would not pay her bills, claiming that this was a preexisting condition. She had no idea about it, since she had never met an Asian beetle before!

Banning the exclusion of such preexisting conditions was perhaps the most popular element of Obamacare. It ensured that all Americans, regardless of their life circumstances, could not be bankrupted by some genetic flaw beyond their control.

The sponsors of the law have put forth two false arguments to claim that this isn’t the case. First, they argue that even in those opt-out states, the law would maintain mandated coverage of preexisting conditions. But the law would also allow insurers to simply price those individuals out of the insurance market because it would remove “community rating,” or the mandate that sick individuals be charged no more than healthy individuals for insurance. So insurers would have had to cover the Tennessee woman’s beetle allergy—but they could have charged her 10 times as much for her insurance if they knew about it beforehand. This was a common practice before 2014, as insurers would use discriminatory pricing to keep the sick out of the insurance market.

The second argument is that the law sets up high-risk pools that provide an alternative means of coverage for individuals with preexisting conditions. But if such pools have only sick people in them, then insurers will want to charge enormous premiums; when such pools were set up under Obamacare as a transition mechanism in 2010, the average annual cost of an enrollee was $32,000. Most individuals can’t afford a premium at that level, so to make this affordable would require enormous government subsidies. But the law—even with the last-minute addition of $8 billion in subsidies—includes only a small portion of the funds that would be required by even the most conservative efforts. This is not a high-risk pool: it is a high-risk puddle.

In order to pass their Obamacare alternative, Republicans want to return Americans to a world where someone can be priced out of insurance because of a genetic defect that they might have not even known about. Even Americans who won’t be directly affected by this change should be disgusted by the GOP’s dangerous new plan.

About the Author
By Jonathan Gruber
See full bioRight Arrow Button Icon
Add Fortune on Google for similar content.

Latest in Commentary

Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025

Most Popular

Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Fortune Secondary Logo
Rankings
  • 100 Best Companies
  • Fortune 500
  • Global 500
  • Fortune 500 Europe
  • Most Powerful Women
  • World's Most Admired Companies
  • See All Rankings
  • Lists Calendar
Sections
  • Finance
  • Fortune Crypto
  • Features
  • Leadership
  • Health
  • Commentary
  • Success
  • Retail
  • Mpw
  • Tech
  • Lifestyle
  • CEO Initiative
  • Asia
  • Politics
  • Conferences
  • Europe
  • Newsletters
  • Personal Finance
  • Environment
  • Magazine
  • Education
Customer Support
  • Frequently Asked Questions
  • Customer Service Portal
  • Privacy Policy
  • Terms Of Use
  • Single Issues For Purchase
  • International Print
Commercial Services
  • Advertising
  • Fortune Brand Studio
  • Fortune Analytics
  • Fortune Conferences
  • Business Development
  • Group Subscriptions
About Us
  • About Us
  • Press Center
  • Work At Fortune
  • Terms And Conditions
  • Site Map
  • About Us
  • Press Center
  • Work At Fortune
  • Terms And Conditions
  • Site Map
  • Facebook icon
  • Twitter icon
  • LinkedIn icon
  • Instagram icon
  • Pinterest icon

Latest in Commentary

k
Commentary250 Years of Innovation
Media leadership unity in defying Trump’s assault on free speech: standing tall against historic comparisons
By Jeffrey Sonnenfeld, Jeff Bewkes, Kay Koplovitz, Tom Glocer and Marvin KalbJuly 4, 2026
12 hours ago
ds
CommentarySoftware
I argued with the father of open source for 2 years. Now the AI fight is the same — only bigger
By David SiegelJuly 3, 2026
1 day ago
ashok
Commentary250 Years of Innovation
The greatest startup in history: What we can learn from America’s founders at today’s AI frontier
By Ashok N. SrivastavaJuly 3, 2026
1 day ago
2
Commentary250 Years of Innovation
America’s secret weapon isn’t just innovation — It’s the freedom to fail
By Keith KrachJuly 3, 2026
2 days ago
rn
CommentaryCryptocurrency
Former Iran director at NSC: Crypto legislation is a ticket to sanctions evasion
By Richard NephewJuly 2, 2026
2 days ago
m
Commentary250 Years of Innovation
McKinsey chairs: Building a more resilient industrial base may require $2 trillion in investment
By Eric Kutcher and Shubham SinghalJuly 2, 2026
2 days ago

Most Popular

Egg companies made $1.22 billion in profit off a $6 carton — now they’re buying their way out of a price-fixing case with 53 million donated eggs
Law
Egg companies made $1.22 billion in profit off a $6 carton — now they’re buying their way out of a price-fixing case with 53 million donated eggs
By Wyatte Grantham-Philips and The Associated PressJuly 2, 2026
2 days ago
Even as Elon Musk calls philanthropy ‘very hard,’ everyday Americans gave a record $617 billion—despite feeling the squeeze over the cost of living
Success
Even as Elon Musk calls philanthropy ‘very hard,’ everyday Americans gave a record $617 billion—despite feeling the squeeze over the cost of living
By Preston ForeJuly 4, 2026
16 hours ago
Meet the Zillennials: The luckiest micro-generation in the workforce, born between 1993 and 1998
AI
Meet the Zillennials: The luckiest micro-generation in the workforce, born between 1993 and 1998
By Nick LichtenbergJuly 3, 2026
2 days ago
Economists have found an answer to slowing cognitive decline: Avoid retiring early, study finds
Economy
Economists have found an answer to slowing cognitive decline: Avoid retiring early, study finds
By Sasha RogelbergJuly 2, 2026
2 days ago
$25 billion CEO says one-hour interviews are a waste of time—he puts candidates through six hours of tests and wants them to order wine at lunch
Success
$25 billion CEO says one-hour interviews are a waste of time—he puts candidates through six hours of tests and wants them to order wine at lunch
By Orianna Rosa RoyleJuly 3, 2026
2 days ago
Philanthropy leader at Warren Buffett and Bill Gates’ Giving Pledge says children of billionaires are pushing them to give their wealth away faster
Success
Philanthropy leader at Warren Buffett and Bill Gates’ Giving Pledge says children of billionaires are pushing them to give their wealth away faster
By Preston ForeJune 27, 2026
8 days ago

© 2026 Fortune Media IP Limited. All Rights Reserved. Use of this site constitutes acceptance of our Terms of Use and Privacy Policy | CA Notice at Collection and Privacy Notice | Do Not Sell/Share My Personal Information
FORTUNE is a trademark of Fortune Media IP Limited, registered in the U.S. and other countries. FORTUNE may receive compensation for some links to products and services on this website. Offers may be subject to change without notice.