Prior to the passage of the Affordable Care Act(ACA), approximately 30% of individual applicants for health insurance were denied coverage due to the existence of a pre-existing condition (PEC)(1).
The elimination of discrimination based upon PECs is by far the most popular provision of the ACA. In fact, Ben Carson, who once compared the ACA to Slavery, said the one thing he is grateful for and would keep is the elimination of PECs as a reason to block someone from insurance coverage(2).
Prior to the ACA, several states attempted to eliminate discrimination based on PECs for insurers operating within their states by simply guaranteeing issue: anyone who wanted insurance could get it regardless of health status.
Within those states, premiums skyrocketed and insurers fled as more unhealthy people enrolled in insurance plans while healthier people dropped out of coverage each year. New Jersey families saw their premiums go from $6048-$12,912 per year in 1994 to $38,060-$210,600 per year by 2002. In Kentucky, the individual insurance market collapsed as insurers lost hundreds of millions of dollars(3). This is what is known as an insurance "Death Spiral"
In 2006, Massachusetts politicians enacted a policy mandating all residents to enroll in an insurance plan or pay a penalty. The goal of this was to preserve the role of private health insureres like Blue Cross Blue Shield in the individual marketplace while still providing guaranteed issue for residents. For those who couldn't afford coverage, the state provided financial assistance to purchase insurance. Republican Governor Mitt Romney, with the help of MIT professor Johnathan Gruber and others, developed and passed" An Act Providing Access to Affordable, Quality, Accountable Health Care“, better known as RomneyCare.
The ACA is actually very similar to the RomneyCare model(4). In fact, despite some claims, ACA architect Johnathan Gruber was instrumental in providing the administration the technical knowledge and support on how to implement the Massachusetts model nationally(5).
Quietly, Senator Marco Rubio successfully led an effort in congress to curb payments to health insurance companies and health co-ops to offset losses due to the ACA(6).
Though 2017 premiums are scheduled to increase at the highest rate since the start of the ACA, there is evidence to suggest the risk pools are improving and 2017 may be a one-time event(7).