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

Exclusive

An hour in the Oval Office with President Trump Fortune Editor-in-Chief: Alyson Shontell sat down with President Trump in the Oval Office for an hour. Tariffs, Intel, AI, Boeing, Iran—and the question every CEO eventually has to answer: who's next?

An hour in the Oval Office with President Trump Fortune Editor-in-Chief: Alyson Shontell sat down with President Trump in the Oval Office for an hour. Tariffs, Intel, AI, Boeing, Iran—and the question every CEO eventually has to answer: who's next?

An hour in the Oval Office with President Trump Fortune Editor-in-Chief: Alyson Shontell sat down with President Trump in the Oval Office for an hour. Tariffs, Intel, AI, Boeing, Iran—and the question every CEO eventually has to answer: who's next?

An hour in the Oval Office with President Trump Fortune Editor-in-Chief: Alyson Shontell sat down with President Trump in the Oval Office for an hour. Tariffs, Intel, AI, Boeing, Iran—and the question every CEO eventually has to answer: who's next?

An hour in the Oval Office with President Trump Fortune Editor-in-Chief: Alyson Shontell sat down with President Trump in the Oval Office for an hour. Tariffs, Intel, AI, Boeing, Iran—and the question every CEO eventually has to answer: who's next?

An hour in the Oval Office with President Trump Fortune Editor-in-Chief: Alyson Shontell sat down with President Trump in the Oval Office for an hour. Tariffs, Intel, AI, Boeing, Iran—and the question every CEO eventually has to answer: who's next?

An hour in the Oval Office with President Trump Fortune Editor-in-Chief: Alyson Shontell sat down with President Trump in the Oval Office for an hour. Tariffs, Intel, AI, Boeing, Iran—and the question every CEO eventually has to answer: who's next?

An hour in the Oval Office with President Trump Fortune Editor-in-Chief: Alyson Shontell sat down with President Trump in the Oval Office for an hour. Tariffs, Intel, AI, Boeing, Iran—and the question every CEO eventually has to answer: who's next?

An hour in the Oval Office with President Trump Fortune Editor-in-Chief: Alyson Shontell sat down with President Trump in the Oval Office for an hour. Tariffs, Intel, AI, Boeing, Iran—and the question every CEO eventually has to answer: who's next?

An hour in the Oval Office with President Trump Fortune Editor-in-Chief: Alyson Shontell sat down with President Trump in the Oval Office for an hour. Tariffs, Intel, AI, Boeing, Iran—and the question every CEO eventually has to answer: who's next?

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

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

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

‘Change the World’ idealism is dying in Silicon Valley. We’ll miss it when it’s gone
CommentarySilicon Valley
‘Change the World’ idealism is dying in Silicon Valley. We’ll miss it when it’s gone
By Jonathan WeberMay 19, 2026
4 hours ago
reorgs
CommentaryRestructuring
We studied 6,000 executives and found the real reason 70% of transformations fail
By Julia Dhar, Kristy R. Ellmer and Philip JamesonMay 19, 2026
6 hours ago
joel
Commentarysaas
The SaaSpocalypse isn’t killing software. It’s exposing where software value really lives
By Joel HronMay 19, 2026
7 hours ago
altman
CommentarySam Altman
Musk vs. Altman: AI safety cannot be one man’s job
By Stavros GadinisMay 18, 2026
19 hours ago
charlie
CommentarySoftware
Anaplan CEO: AI isn’t eating software. It’s sorting it
By Charlie GottdienerMay 18, 2026
1 day ago
shyam
CommentaryHealth
World Economic Forum: women’s health gets only 20% of R&D funding. We must seize this $1 trillion opportunity
By Shyam BishenMay 18, 2026
2 days ago

Most Popular

While Trump insisted the Iran war would end ‘soon,’ an account in his name was buying millions in oil, defense and gold
Economy
While Trump insisted the Iran war would end ‘soon,’ an account in his name was buying millions in oil, defense and gold
By Eva RoytburgMay 18, 2026
22 hours ago
The Bezos family just donated $100 million to help achieve one of Mayor Zohran Mamdani’s top campaign promises
Politics
The Bezos family just donated $100 million to help achieve one of Mayor Zohran Mamdani’s top campaign promises
By Jake AngeloMay 12, 2026
7 days ago
Current price of oil as of May 18, 2026
Personal Finance
Current price of oil as of May 18, 2026
By Joseph HostetlerMay 18, 2026
1 day ago
EXCLUSIVE: An hour in the Oval Office with the CEO-in-Chief, President Trump
Politics
EXCLUSIVE: An hour in the Oval Office with the CEO-in-Chief, President Trump
By Alyson ShontellMay 18, 2026
1 day ago
Spirit Airlines apologizes to all the Americans who can't afford any summer vacation flights as it shuts down
Travel & Leisure
Spirit Airlines apologizes to all the Americans who can't afford any summer vacation flights as it shuts down
By Rio Yamat and The Associated PressMay 18, 2026
1 day ago
Current price of silver as of Monday, May 18, 2026
Personal Finance
Current price of silver as of Monday, May 18, 2026
By Joseph HostetlerMay 18, 2026
1 day 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.