We said in our last post that Trumpcare will allow insurers to raise premiums on those with preexisting conditions. The Affordable Care Act/Obamacare prohibits exclusions for preexisting conditions (see Subtitle C – Quality Health Insurance Coverage for All Americans, Subpart I, pg 45 of the ACA).
The relevant section of the Republican Health Care law that deals with preexisting conditions is the so-called MacArthur Amendment. States are allowed to seek waivers for the “essential health benefits” mentioned in our previous blog entry. The essential health benefits waiver provision is provided in section B on page 2 of the MacArthur Amendment.
Republican politicians will be quick to point out that Section 137, (b) explicitly says, “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.” Section 137 is on page 7 of the MacArthur Amendment. Insofar as I can see, section 137 is a restriction on health insurance issuers, not states. To be clear, states are allowed to apply for, and obtain waivers that excuse them from providing essential health benefits in the ACA. Remember, section B, the section that allows states to obtain a waiver for the essential health benefits of the ACA, falls under section 136. The heading for section 136 is “Permitting States to Waive Certain ACA Requirements to Encourage Fair Health Insurance Premiums.” A state can allow insurance companies to be exempt from providing the ten benefits we itemized in our previous blog post if it thinks it will “encourage fair health insurance premiums.” What is a fair health insurance premium?
Digression: Note the difference you experience on this blog. We point to the law itself so that you can gain direct knowledge of relevant legislative actions.
According to CNN:
The Affordable Care Act that rolled out under President Barack Obama mandated that insurers charge everyone the same amount, regardless of their health history, and that they cover essential health benefits, such as prescription drugs, hospitalization and doctors’ visits.
The Trump administration’s American Health Care Act — which squeaked through in the House on Thursday but must still be voted on by the Senate — will allow insurance companies to raise prices for those with pre-existing conditions and to not guarantee that treatments are covered.
And the LA Times puts it succinctly:
A key focus of the GOP has been a provision of the Affordable Care Act that people with preexisting conditions not be discriminated against in any way by health insurers. Prior to Obamacare, insurers could deny coverage to such people or charge premiums beyond most people’s ability to pay.
The MacArthur Amendment would empower states to waive protections for those with preexisting conditions as long as they come up with some alternative way of making insurance available.
The catch, however, is that the amendment would not require insurers to charge the same rates that healthy people enjoy. That’s why the likes of the American Medical Assn. and AARP have warned that, under the Republican plan, sick people could face rates so high that they’d be unaffordable for any but the wealthy.
3. Alcohol Addiction/Abuse
9. Congestive Heart Failre
10. Crohn’s Disease
11. Cerebral Palsy (infantile)
12. Cystic Fibrosis
14. Domestic Violence Survivor
16. Drug Addiction/Abuse
17. Eating Disorders
20. Menstrual irregularities
22. Heart Attack
24. Irritable Bowel Syndrome
25. Kidney Disease
28. Mental Disorders
29. Muscular Dystrophy
31. Organ Transplant
33. Parkinson’s Disease
34. Pending Surgery
35. Postpartum Depression
37. Rape Survivor
38. Sleep Apnea
I want to make my closing point with precision. Trumpcare does not allow insures to deny coverage for things like rape, pregnancy, or anything else on this list. The bill does allow for people with preexisting conditions to be placed in high risk pools that could lead to prohibitively high premiums.
Here’s how CBS News puts it:
This bill, unlike the GOP’s first failed attempt to pass a bill to replace Obamacare, also has the support of the conservative Freedom Caucus. But does it guarantee coverage of pre-existing medical conditions, as Mr. Trump and the bill itself say?
Under the new Republican bill, states have the ability to apply for three different waivers from regulations under Obamacare if they can prove that doing so will reduce average premiums, increase enrollment, stabilize the health insurance coverage market or increase the choice of health plans in the state. One of those waivers applies to pre-existing conditions, allowing insurers to use “health status” — that is, current health, health history and other risk factors — to set insurance premiums.
While the MacArthur Amendment expressly forbids insurers from turning down people with pre-existing conditions, they could, based on your health status, “offer you a policy that could end up charging you thousands,” said Karen Pollitz, Senior Fellow with the Kaiser Family Foundation.
Do you or someone you know have any of these preexisting conditions?