How Accessible and Affordable were Individual Market Health Plans before the Affordable Care Act?

The affordability and accessibility of health plans on the individual market varied greatly from state to state before the implementation of the Affordable Care Act (ACA).

The Issue

Before the ACA, the price of insurance plans, what the plans covered, and how easy they were to purchase were determined in large part by a person's health status and where he or she lived.

Key Findings

  • In most states, having a pre-existing condition pre-ACA could mean denied coverage, higher costs, or having that pre-existing condition excluded from your health plan.

  • Forty-four states and D.C. allowed insurers to deny coverage to people with pre-existing conditions.

  • Thirty-two states imposed no rating restrictions on insurers before the ACA, which resulted in higher premiums for older individuals, women, and those in less-than-perfect health.


The ACA created a minimum level of protections for those seeking and enrolling into coverage on the individual market. A look back at the insurance protections that existed before the ACA highlights what consumers with health issues have at stake.

About Georgetown University’s Health Policy Institute

The Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute is a nonpartisan, expert team of faculty and staff dedicated to conducting research on the complex and developing relationship between state and federal oversight of health insurance markets.