Is It True That TrumpCare Eliminates ObamaCare’s Pre-Existing Conditions?
TrumpCare weakens (not eliminates) key protections for those with pre-existing conditions, which could result in some being excluded from the market due to cost.
In other words,
- It is a MYTH that TrumpCare eliminates all of ObamaCare’s pre-existing conditions protections. Coverage is still guaranteed issue and consumers can’t be charged a higher ratio directly.
- It is a FACT that TrumpCare weakens key patient protections that will affect those with pre-existing conditions. It will result in some people losing coverage, paying more, or being forced to rely on a high-risk pool.
Under TrumpCare (the American HealthCare Act bill that passed the House, but not the Senate) the following things could affect those with pre-existing conditions:
- While bans on discriminating against pre-existing conditions are kept, some essential health benefits can be excluded from plans on a state level by using a state-based waiver. If an essential benefit is excluded, then annual and lifetime limits can be charged, and plans won’t have to cover certain benefits. In these states, a high-risk pool must be implemented. However, those state pools are under-funded in the current House bill. This means, in states that implement the waiver, people with pre-existing conditions could be subject to lifetime and annual limits, excluded from the market due to cost, placed in a high-risk pool, or excluded from the pool and market altogether.
- Instead of mandates, TrumpCare has a fee for re-entering the market. That means the employer mandate to ensure full-time workers is gone. Although there is no direct fee for going without coverage, those who re-enter the market after having lost a plan for 63 days or more have to pay 30% more for 12 months. This could affect those with pre-existing conditions. This is called the “continuous coverage provision.”
- Out-of-pocket cost assistance is eliminated. That means those with pre-existing conditions and lower incomes could see less cost assistance.
- Tax credits are based on age and not income. That means less assistance for many, especially those who are older and have high costs. TrumpCare costs will be damaging for people with incomes between 400% – 600% of the poverty level.
- Medicaid expansion funding is frozen. That means those who rely on Medicaid due to income may have no options.
- Older Americans can be charged a 5:1 ratio. That means older Americans with lower incomes are at risk of being excluded based on cost.
As the bill stands now (having passed the House, but not the Senate), those with pre-existing conditions cannot be excluded from the market directly. However, they can be excluded from the market by weakened protections, the freezing of Medicaid, state-level waivers, new ratios, the fee for re-entering the market, and less assistance.
FACT: As stated by Forbes, according to research from Avalere Health, just 5% of Americans with preexisting conditions who currently have individual coverage will benefit from funds written into the American Health Care Act. There are major concerns over funding with the risk pools.
FACT: As many as 1 in 2 Americans have a condition that could count as a pre-existing condition and, although not every possible pre-existing condition would be excluded, a portion of the 50% with pre-existing conditions could see new hurdles under TrumpCare.
FACT: The plan before the Amendments had a price tag that came in under the ACA according to the Congressional Budget Office, saving $337 billion over the decade according to their first report. However, it did this by leaving 52 million without coverage by 2026. It increases the number of uninsured people by 24 million by 2026. TrumpCare leaves a total of 52 million Americans without health insurance. The cost and uninsured rate are subject to change based on changes to the bill.
For more details see: TrumpCare and Pre-Existing Conditions or a simple summary of TrumpCare (the American Health Care Act).