Notably, former President Trump mentioned “concepts of a plan” during last month’s presidential debate when asked about his healthcare reform proposal. Now his running mate, Senator JD Vance, says there is a plan to “fix health care,” particularly with regard to the Affordable Care Act.

Vance argues that the health insurance market needs to be deregulated. He talks about accommodating people with chronic illnesses in separate insurance communities. However, this could lead to insurers charging higher premiums for people with pre-existing conditions.

Kamala Harris’ campaign released a report yesterday claiming that millions of people with pre-existing conditions could lose the protections guaranteed to them by the ACA rules if Vance’s changes are implemented.

During his time in office, Trump attempted to undo the ACA through executive actions, legislation, and lawsuits. But the law survived. And during Trump’s bid to secure a second term as president, he wavered on the idea of ​​repealing the ACA.

But perhaps given that the ACA is popular and enrollment is rising and the number of uninsured is at historic lows, instead of repealing the ACA, Trump is now calling for what he calls improvements to the law. His vice president, Vance, is proposing significant changes to ACA health insurance coverage that could lead to the elimination of ACA protections against insurers that charge higher premiums to people in poor health.

Vance has spoken of deregulation of the insurance market so that “people can choose a plan that actually makes sense for them,” as reported in The hill. During the North Carolina election campaign last month, for example, Vance proposed eliminating the ACA’s individual risk pool, which allows for community assessment, and creating separate risk pools for people with chronic health problems. This would violate one of the ACA’s guiding principles, which states that health insurers cannot charge people higher premiums based on their health status.

KFF estimates that 27% of adults have a condition that would have caused them to be denied coverage by an insurer in the individual market before the ACA. Before the law was passed, insurers could deny coverage for a variety of illnesses or charge significantly higher premiums to people with pre-existing conditions.

Vance wants to leave the decision on how insurers handle the high-risk insurance pools mentioned above to individual states. If certain states then allow premium surcharges based on health status, people with pre-existing conditions would theoretically have access to health insurance, but it could be unaffordable.

State high-risk pools could provide people with pre-existing conditions with access to insurance coverage as an alternative to the private insurance market. However, whether such pools would be effective depends on adequate funding, which was not the case in the states that established them before the ACA took effect. And so these insurance communities were not a viable option for many due to the excessive premiums.

Vance also said, “We’re actually going to implement regulatory reform in the health care system that allows people to choose a health plan that works for them.” If you only go to the doctor once a year, you need a different health plan than someone who who goes to the doctor fourteen times a year because he has chronic pain or another chronic illness.”

While it’s unclear what specifically Vance has in mind for healthier people, he may be referring to short-term insurance plans that the Trump administration has promoted and made more accessible. These options do not offer as comprehensive protection as ACA plans. Some healthy people may have an incentive to choose short-term insurance that can be renewed every three to 12 months to lower premiums.

The problem is that this can significantly increase costs for sick people who continue to participate in ACA exchange plans. Furthermore, the idea of ​​offering healthy people a cheaper plan with far less complete coverage implicitly assumes that people’s health needs are static, which they often are not. Perhaps the most important goal of health insurance is financial security unforeseen Events. The fact that you only go to the doctor once today has no impact on the future, be it next year or later.

Only 39% of survey participants surveyed by KFF in February of this year knew that the ACA prohibits insurers from denying coverage to people with pre-existing conditions, and only 31% knew that the ACA also prevents sick people from being charged higher premiums than healthy people Persons . Given Vance’s statements about ACA reform, it seems important that voters be better informed about what the proposed changes could entail.