This is one among many of the points that should be remembered as we face the threat of ACA repeal. Here’s a Blue Shield underwriting table from just before the ACA. Once a week therapy for even mild depression, anxiety, or any adjustment problem puts you in the “possibly eligibility at a higher tier rate,” adding a medication to that then introduces the possibility that coverage will be denied entirely. If are diagnosed with any other mental illness, that’s another pre-existing condition. Any treatment for ADHD gets you X’s in the columns for”possibly eligibility at a higher tier rate,” and “possible or probable decline”. If you attempted suicide, your application would just be auto-declined without a review of your application for three years following your attempt. Anyone with bipolar or a psychotic disorder was also automatically declined. Pre-existing conditions don’t just affect people on the individual market: before the ACA, your employer’s insurance could refuse to cover you for a year. The pre-existing condition exclusions before the ACA created strong incentives to avoid treatment for mental illness, or to pay out of pocket if you possibly could and lie about your treatment history. If you accepted treatment for mental illness, you would heavily compromise any treatment for physical illness down the line. More generally, this analysis by the Department of Health and Human Services before the ACA found that as many as 1 in 2 non-elderly Americans might have a pre-existing condition.
The number of people who have been protected by the ACA is massive, and the elimination of pre-existing condition exclusions is just one of the protections afforded by the law.