TrumpCare and Pre-Existing Conditions

Does TrumpCare Cover Pre-Existing Conditions?

We explain how TrumpCare affects those with pre-existing conditions to help clear up the confusion regarding TrumpCare and Pre-existing conditions.

UPDATE 2019: This plan never passed, and thus the specifics here are of historical interest only.

The Basics of TrumpCare and Pre-Existing Conditions

Generally speaking,

• Under ObamaCare (the Affordable Care Act) no one with pre-existing conditions can be denied coverage or charged higher insurance rates. ObamaCare also covers essential health benefits with no lifetime or annual limits, offers cost assistance based on income, expanded Medicaid to all low-income adults (in states that chose to expand), and limited ratios of what people could be charged based on age.
• TrumpCare (the American HealthCare Act bill that passed the House, but not the Senate) doesn’t eliminate the ban on pre-existing conditions (coverage is still guaranteed issue and consumers can’t be charged a higher ratio directly). However, it does make changes to essential benefits, cost assistance, Medicaid expansion, and ratios that could result in those with pre-existing conditions being excluded from the market due to cost.

In a few words, TrumpCare weakens (not eliminates) key protections for women, seniors, low-income Americans, and those with pre-existing conditions, which could result in tens of millions (including those with pre-existing conditions) being excluded to from the market or placed in a high-risk pool due to cost.

The Details on TrumpCare and Pre-Existing Conditions

Under TrumpCare the following things could affect 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 pools are under-funded in the current House bill. This means, in states that implement the waiver, those with pre-existing conditions could be subject to life-time and annual limits, or excluded from the market due to cost, or placed in a high-risk pool, or excluded from the pool and market all together.
• The mandates are replaced with a fee for re-entering the market. That means the employer mandate to ensure full-time workers is gone and, although there is no direct fee for not having 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, but more for others 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.

In other words, the bottom line here is that as the bill stands now (passing the House, but not the Senate), those with pre-existing conditions can not be excluded from the market directly, but they can be indirectly excluded from the market due to weakened protections, state-level waivers, and less assistance.

Thus, people are very right to be upset, protections are being taken away. However, TrumpCare does not eliminate pre-existing conditions directly (the idea that TrumpCare eliminates pre-existing conditions – period – is a myth).

That means, like many things healthcare, “its complicated.”

It is likely this complexity paired with the quick succession of changes, and the emotions people are feeling over the changes, has led to the confusion over exactly what TrumpCare does. With that in mind, you can learn more about TrumpCare here.

Considering the Amendments

Consider, the waivers for essential benefits were in an Amendment added to the bill right before it passed the House.

To make things more complex, the waivers also allowed for state-based high-risk pools (if a state excludes essential benefits, they must also establish a high-risk pool).

However, 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.

House Republicans were aware that the funding provided in the “MacArthur Amendments” wasn’t enough, and added $8 billion via the “Upton Amendment.” However, that $8 billion isn’t nearly enough to fund the new high-risk pools. This alone is one of many problems compounding with the ones noted above.

Phrasing the TrumpCare and Pre-Existing Conditions Situation

If one wants to speak truthfully without diving into the whole explainer above, they can simply say, “TrumpCare/ The American Healthcare Act weakens pre-existing conditions protections.”

Or more generally, “TrumpCare/ The American Healthcare Act weakens protections for women, seniors, low-income Americans, and those with pre-existing conditions.”

If one wants to add more detail they can say, “The state waivers, paired with reduced cost assistance, a fee for re-entering the market, less employers offering health plans, and the freezing of Medicaid expansion could lead to many being effectively excluded from insurance due to having a pre-existing condition (the effect is indirect, not direct).”

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 those 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 uninsured by 24 million by 2026 for a total of 52 million). The cost and uninsured rate are subject to change based on changes to the bill.