Important Note on Pre-Existing Conditions
We’ve noticed that some outlets are reporting that individuals with pre-existing conditions will now be taken care of under the Senate’s TrumpCare bill. THIS IS NOT ACCURATE. Under the Senate bill, people with pre-existing conditions can STILL be discriminated against, as they would be under the House bill. Here’s how:
1) The Senate TrumpCare bill allow states to waive consumer protections and market reforms – without requiring them to demonstrate that the coverage will be equally affordable and comprehensive.
This is a letter from HHS Secretary Tom Price that lays out how the ACA waivers work right now:
“Under Section 1332 of the ACA, states can apply for State Innovation Waivers and pursue · innovative strategies to adapt many of the law's requirements to suit the state's specific needs. To receive approval, the state must demonstrate that a proposed waiver will provide access to quality health care that is at least as comprehensive and affordable as would be provided without the waiver, will provide coverage to at least a comparable number of residents of the state as would be provided coverage without a waiver, and will not increase the federal deficit.”
(https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Downloads/March-13-2017-letter_508.pdf)
Section 206 of the American Health Care Act eliminated the highlighted requirements, including affordability, stipulating only that waivers should reduce “average premiums.”
2) Using this waiver, states could waive the single risk pool requirement, relegating those with pre-existing conditions to a high-risk pool, with higher premiums and higher out-of-pocket costs. Requiring a reduction in “average” premiums does nothing to ensure affordability or even coverage for those with pre-existing conditions in high-risk pools – in fact it’s an incentive for states to deliberately make coverage unaffordable for certain segments of the population. To be blunt: it’s easy to reduce averages when you drop the costlier people who need coverage the most.
3) Also under this waiver, states could waive Essential Health Benefits, which would indirectly subject people with pre-existing condition to discrimination based on the services needed to treat their particular conditions. Some good explainers of why this is the case: