Confused About Preexisting Conditions Under the AHCA? Here’s The Breakdown.
- Brittany Kilpatrick, Co-Founder
- May 9, 2017
- 6 min read
Last week, the U.S. House of Representatives (read: Republicans) passed the American Health Care Act or “AHCA,” which, when said aloud, sounds fittingly like the noise you make when you sneeze and cough at the same time (evidently, this occurrence has a name: a “snough,” per Urban Dictionary). Compared to the twenty-thousand page Affordable Care Act (ACA), the AHCA weighs in at barely two-hundred pages. If you have even a minutia of understanding of the complexities of the U.S. healthcare system, or perhaps, you’ve just heard Donald Trump speak on any topic for over thirty seconds, and this concerns you, you aren’t alone. Yesterday, healthcare demonstrations took place all over the country, calling on the Trump Administration to ensure healthcare for everyone, not just those in the the tax bracket that can afford Mar-a-Lago membership dues. While the new healthcare bill aims to change many aspects of the ACA, most of the concerns center squarely on how preexisting conditions can, once again, factor into whether a person can obtain health coverage. So let’s break it down.
The Wild West That Was Life Before The ACA
Back in the Wild West that was pre-Obamacare health insurance, insurance companies could do absurd things like offer really cheap health insurance policies that covered next-to-nothing, or that charged a high deductible or co-pay for such claims. They could charge the sick ridiculously high prices for coverage, or refuse to cover them at all. Without the coveted employer-sponsored plans, each person was individually evaluated by what they brought to the table. Mental illness? High blood pressure? High cholesterol? Diabetes? Being a woman? Insert-other-conditions-you-cannot-control? You’re paying more, Barbara. Under the ACA, insurers are required to charge people the same amount, regardless of their health status.
Enter: Trumpcare 2.0, which differs only slightly from version 1.0, yet, is still touted to cover everyone, for less, while maintaining the highly illusionary appearance of a “free-market” insurance system. If it sounds like a fantasy, that’s because it is. The realities of designing a healthcare system that pats-its-head-and-rubs-its-belly at the same time are far more sophisticated than anyone in the Statutory Writing Department of the Freedom Caucus ever imagined.
The Breakdown: What You Need To Know About Preexisting Conditions Under the AHCA
For weeks, the Trump Administration and Republican lawmakers have insisted that no one with a preexisting condition will be denied health insurance under the law. They point to the following language in the bill:
“Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”
Examination of the totality of AHCA bill reveals a more complex situation, and Donald Trump, is by no means, an aficionado of nuance. In the current iteration of the bill, individual states may apply for a waiver that allows for them to consider “health status,” and thereby, preexisting conditions in pricing insurance premiums.
More specifically, states who want to ensure that private health insurance companies operating within their state have more control over premium pricing, will seek a waiver from the continuous coverage provision. The continuous coverage provision requires that insurance companies, under the AHCA, charge purchasers a thirty percent penalty if they obtain insurance coverage in a given year without having been insured the year prior. To Republican lawmakers, the penalty is less coercive than an individual mandate, because it doesn’t statutorily require people to purchase insurance. (If you’re raising your eyebrow because this sounds like a less equitable version of the current ACA penalty scheme, you get a gold star!)
The continuous coverage provision was an attempt to pinpoint the most expensive group of people to insure: the poor and sick. For the most part, the continuous coverage provision will primarily and negatively impact people who are too sick to hold down steady employment and too poor to maintain consistent health insurance. However, the provision will ultimately affect a wide range of people, from the incredibly sick, to graduates who have not yet entered the workforce, people who are self-employed or work for a small business, or someone in between jobs.
To incentivize private insurance companies to participate in the AHCA, and simultaneously prevent an insurance market death spiral, Republican lawmakers added the continuous coverage waiver, also known as the MacArthur Amendment. It’s basically an assurance that someone will show up to the insurance market party, so Republicans won’t be left alone with their fruit punch and Wheat Thins. States concerned about keeping health care premiums affordable for the people who don’t desperately and immediately need health insurance (read: the employed and healthy) may apply for waivers to opt out of the continuous coverage provision. For a state who obtains a waiver from the continuous coverage provision, insurance companies may subsequently consider current and preexisting health conditions in determining premiums for those who lapsed on their insurance for at least sixty-three days the year prior to purchasing it.
In other words, your preexisting conditions will be factored into the price of your insurance premiums if you:
1.) live in a state that seeks and is granted this waiver;
2.) have a lapse in health coverage (for longer than 63 days);
3.) and purchase insurance on the individual or small-group market.
Supposing a person meets the three aforementioned requirements, they’ll be placed in a separate, subsidized risk pool. Allegedly, their obscenely-high premiums will be offset by money set aside by the federal government for this risk pool. Unfortunately for the Trump Administration and Republican lawmakers, there’s a problem with the math. Researchers are very concerned that the allocated amount is not enough to sustain the high risk pools. Moreover, there are concerns that states can reallocate this money, once received, to people other than those in the high risk pools. The law appears to allow that as of now.
There’s a very good chance many states will not seek a waiver of the continuous coverage provision, particularly established blue states (i.e. the California, New York, Vermont variety). If you happen to live in a profoundly red (i.e. South Carolina, Georgia, Texas) or swing state (i.e. Ohio, Pennsylvania, Florida), it’s good to know what could be coming down the political pike.
What Qualifies As A Preexisting Condition?
If you’re like me and just-so-happen to live in a red or swing state that would likely (definitely) seek the waiver, the next logical question is what qualifies as a “preexisting condition.” Since the AHCA could only take place under conditions akin to the Lord of the Flies, or, as Paul Ryan likes to call it, the “free market,” it’s entirely up to each private insurance company to determine what medical conditions are considered preexisting conditions. Uncertainty -- just what sick people need.
Fortunately for us, the Kaiser Family Foundation compiled a list of medical conditions that, prior to the ACA, insurers routinely used to deny coverage or inflate premium prices. Some examples include: HIV, treatment for alcohol abuse, mental illness, cancer, heart by-pass surgery, diabetes, Crohn’s disease, obesity, pending surgery, pregnancy or a man whose partner is expecting a baby, and sleep apnea.
What You Can Do
Healthcare organizations and professionals, hospitals, and researchers alike are very concerned about this bill. Groups like the the American Medical Association, the American Hospital Association, the AARP, the American Cancer Society Cancer Action Network, the American Heart Association and many others publicly oppose the bill.
As an individual, there is a lot you can do to preclude the AHCA from becoming law. First, call or write your senators. The bill is currently being debated in the U.S. Senate, so pressure from constituents is more crucial now than ever. Look up your senator’s contact information here: Check out this how-to guide on calling your senator about the AHCA, specifically.
Next, consider demonstrating. Yesterday, the Women’s March organized healthcare-focused sit-ins, protests, and rallies across the country. Subscribe to their email listserv or follow them on social media to keep abreast of the next demonstration. This week, Indivisible is also organizing “Die Ins” at Congressional local and federal offices who support the AHCA to bring awareness to the idea that without health insurance, political representatives are risking the lives of their constituents. Connect with a your local Indivisible to find demonstrations in your area.
Finally, if you can’t call, write, or demonstrate, show your support on social media by sharing articles like these. Get the message out on social media by dispersing the work of others or your own words and experiences. There’s no better time than now to learn how to discuss this issue.
To get you inspired, enjoy a few photos from my local Women’s March healthcare demonstration, which took place yesterday.
Brittany Kilpatrick is an attorney and co-founder of Bonded Magazine. She likes carbs, reading, pondering the intricacies of Donald Trump's spray tan, Beyoncé, Thesaurus.com, musicals, fully replacing her daily water intake with La Croix, and her dog, Tucker.
You can find her on Facebook or Instagram: @brittany.kilpatrick or on Bonded social media: @bondedmag.
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