Thread by @charles_gaba

Yup. Have cancer? Here's a policy that will cover you if you break your arm, but not your chemotherapy.

From an actuarial POV, medical underwriting might make sense. From a human decency POV, not so much.

https://twitter.com/larry_levitt/status/1308105097071607808

Note that the ACA didn't ENTIRELY eliminate premium variances, but it dramatically reduced their scope. Premiums can vary by age...but only by a 3:1 range instead of 5 or 6:1. They can vary by geography w/a state (defined rating areas). And smokers can be charged up to 50% more.

Even within the ACA, some states restrict it even more:
--NY & VT don't allow *any* age variance (1:1 range); MA allows 2:1
--Some small states like DE only have 1 rating area anyway
--Some states don't allow a smoker surcharge or have a smaller cap

But really, medical underwriting is the core of the controversy over "pre-existing conditions". You either think that everyone should be able to get quality healthcare treatment regardless of how "high risk" they are...or you don't.

Note that two of the three pricing variances allowed are objectively measurable without digging into a lot of deeply personal info: How old are they and where do they live?

The smoking surcharge is the exception--someone can smoke one cigarette a year or 2 packs a day.

Aside from smoking, however, the ACA doesn't allow for variances based on your profession or hobbies, for instance--you can't be charged more for being an alligator wrestler or working on a nuclear waste cleanup crew or whatever, or for skydiving in your spare time.

Fun fact re. the ACA 50% smoker surcharge:
--CA, DC, MA, NJ, NY, RI & VT don't allow it at all
--AR restricts it to 20%
--CO restricts it to 15%
--KY restricts it to 40%. That's right: On this particular issue, KENTUCKY is actually MORE strict than Obamacare!