People who have any kind of medical condition are at the heart of the debate over repealing and replacing the Affordable Care Act. About a quarter of adults under 65 have these so-called pre-existing conditions, and they are most vulnerable to any change in the current law, which prohibits charging sick people more for insurance.

The replacement bill that passed the House of Representatives, the American Health Care Act, would allow states to do just that for people with a gap of 63 days in their insurance coverage. It would also allow insurers to stop covering certain services, even for people with continuous coverage. An estimated 23 percent of people who had a gap in their insurance coverage in 2015 also had a preexisting condition.

This means healthy people just keep bouncing around and getting low rates, and the rates for people who don’t do this keep going up,” he says. “The people who are sick would always get creamed.”

In 2001, his organization, the Kaiser Family Foundation, created fake applicants and sent them to insurance companies to see how they would be treated. One hypothetical 56-year-old woman named Emily received a variety of tough responses from insurance companies after disclosing she was on Prozac, according to the San Francisco Chronicle:

Twenty-three percent of the insurers surveyed rejected her, another 23 percent quoted her a higher rate, 12 percent offered her benefits that excluded treatment for mental disorders and 27 percent offered her both higher rates and limited benefits.

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