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What Pre-existing Conditions Does the Newly Proposed Healthcare Bill Not Cover?

Doctor showing new changes could happen in newly proposed healthcare bill

Experts in American healthcare are concerned that the newly proposed healthcare bill, dubbed the American Health Care Act (AHCA), will enable insurers to discriminate against individuals with certain pre-existing conditions such as having a cesarean section or receiving treatment for sexual abuse.

President Donald Trump claims that the final version of the healthcare bill, which narrowly passed the House of Representatives in May, will provide similar protection for people with pre-existing conditions as the Affordable Care Act (ACA). However, it comes nowhere close in its current form.

The ACA bans insurance companies from denying coverage because an applicant has a pre-existing condition. It also does not allow insurers to charge higher premiums to people with pre-existing conditions. It is a very important protective layer for millions of people, but the AHCA could strip away this shield. Although the new bill still has a ban on outright denial of coverage, it enables states to give companies a “waiver” on prices under specific conditions. As a result, insurers can turn back the clock to the pre-ACA days by increasing the cost of premiums on certain conditions deemed pre-existing.

Defending the AHCA

The Speaker of the House, Paul Ryan, maintains that the new plan will still protect people with pre-existing conditions, adding that there is more than one way to solve the problem. The new bill does protect people as long as their coverage doesn’t lapse. While insurers can charge sicker people a higher premium, the AHCA prevents insurance companies from raising prices on you for health reasons as long as you stay on top of your coverage. If you allow coverage to lapse, you can still purchase insurance via the high-risk pool.

According to Steve Scalise, the House Majority Whip, the bill received an extra $8 billion for the sole purpose of helping people with pre-existing conditions. If you have employer health insurance, you will remain unaffected, and thebill does notaffect Medicare or Medicaid. However, the AHCA is receiving criticism as it could cause financial hardship for millions of Americans.

The Trouble with the AHCA

Critics of the bill claim it will make coverage unaffordable for several million people. An Avalere Health study revealed that the $23 billion in funding provided by the bill would cover just 110,000 people. This figure equates to just 5% of the 2.2 million Americans with a pre-existing condition. The bill also has a Patient and State Stability Fund;however, even if every state added in all the money to bring the fund to its maximum limit of $100 billion (unlikely), 1.6 million people will still suffer from lack of coverage.

The outlook is even worse according to the Department of Health and Human Services. It says 130 million Americans under the age of 65 have some kind of pre-existing condition that could make them a target for insurers. These individuals will be in serious trouble should they fall outside the scope of an employer or public health insurance program, which is likely.

The Republican backers of the bill claim it still covers people (with caveats), but their argument holds little water when held under the microscope. Perhaps the main issue is that coverage gaps are extremely common. According to the Kaiser Family Foundation (KFF), over 10 million Americans regularly bought insurance on the open market before the ACA. The number has doubled to 20 million since. All of these individuals are vulnerable under the AHCA.

The majority of people that end up in the coverage gap do so because of sudden unemployment. They lose their employer’s coverage and are unable to afford new insurance as they have a greatly reduced income in unemployment. While the AHCA has subsidies to help, Americans avoid these coverage gaps; the average subsidy of $2,000 to $4,000 is nowhere near enough to purchase a high-quality health insurance policy.

The result was extremely expensive plans with long waiting lists. The AHCA would see a return to the problems mentioned above.

How Will the AHCA Affect You?

For many Americans, the ACA is a lifesaver. Before its implementation, insurers had the power to charge very high premiums and deductibles or refuse coverage to patients with pre-existing conditions. Worse of all, the definition of a pre-existing condition changed from one insurer to the next, causing widespread confusion.

Under the AHCA, we could see a return to this chaos as insurers could place annual and lifetime limits on coverage. As a result, a premature baby on private insurance could exceed its annual limit before it comes home. Before the ACA, there was a large list of pre-existing conditions, including:

  • Epilepsy
  • Cancer
  • Pregnancy
  • Diabetes
  • Heart Disorder
  • Genetic Conditions
  • Mental Disorders

Consequently, patients with seizure disorders could pay almost $100,000 a year in insurance, for example.

According to counsel at the National Women’s Law Center, Rachel Easter, the implementation of the AHCA is especially devastating for women. They suffer from more instances of chronic asthma and arthritis (both are pre-existing conditions under the AHCA) than men, for example. Survivors of sexual assault are also vulnerable under the new bill.

Tens of thousands of Americans likely to suffer from the AHCA took to social media to voice concerns. People suffering from a wide range of conditions (or those with a loved one with the condition) including leukemia, asymmetric septal hypertrophic cardiomyopathy, and cerebral palsy claimed they would face financial ruin if the bill passes the Senate.

Final Words

Millions of people anxiously await the outcome when the Senate votes on the bill. Forensic analysis suggests that in its current form, the AHCA could cause heartache for countless families. The hope is that the bill receives amendments to help people with pre-existing conditions. Otherwise, the members of the U.S. Senate must not vote it through and should instead demand changes.