The 2010 Affordable Care Act created a minimum level of protection for individuals and families purchasing health insurance on the individual market — protection that is now at stake, an issue brief from the Georgetown University Health Policy Institute's Center on Health Insurance Reforms finds. Funded by the Robert Wood Johnson Foundation, the brief, How Accessible and Affordable Were Individual Market Health Plans Before the Affordable Care Act? Depends Where You Lived (6 pages, PDF), found that before the ACA was implemented, the affordability and accessibility of health plans on the individual market varied greatly from state to state and that many protections provided by the ACA were simply unavailable in some states. For example, before passage of the law, only six states required "guaranteed issue," under which insurance companies must issue a health plan to any applicant regardless of health status or demographic factors such as age, gender, and occupation; forty-one states were okay with denial of coverage for preexisting conditions; and thirty-two states imposed no restrictions on how premiums are calculated, allowing insurers to charge higher premiums for the same plan based on an individual's medical history, geographic location, or demographics. With a full repeal of the Affordable Care Act, the brief warns, consumers — and especially those with preexisting health conditions — could lose those and other critical protections.