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Wednesday, February 1, 2017

Republicans’ Empty Promises to Patients with Pre-Existing Conditions

Lydia Mitts

Associate Director of Affordability Initiatives

In their effort to repeal the federal health reform law, Republicans in Congress and President Trump have been outspoken in claiming that they plan to protect people with pre-existing conditions. This is an empty promise.

Based on their past proposals to replace the Affordable Care Act, the Republican replacement plan would drastically weaken protections for people with pre-existing conditions, including people with cancer, diabetes, and high blood pressure. In many cases, they would let insurance companies deny them coverage or charge them unaffordable premiums.

Current health insurance consumer protections under the ACA that are on the line if it is repealed: 

  1. Insurers are not allowed to deny coverage to people with pre-existing conditions. 
  2. Insurers are not allowed to charge people higher premiums because they have a pre-existing health condition. 
  3. Insurers are not allowed to cherry-pick the services they cover, and refuse to cover care that is tied to people’s pre-existing conditions. 
  4. Insurers are not allowed to kick people off coverage or start denying coverage of certain treatments after people enroll in the plan. 
  5. Health plans have to cover a core set of benefits.

None of the proposals Republicans have put forth come close to offering all of these protections. In fact, all of them would essentially pull the rug out from under people with pre-existing conditions. 

Republican replacement plans would gut the protections against discrimination for people with pre-existing conditions

When Republicans claim that they will keep protections for pre-existing conditions, they are invariably referring to replacing those provisions with what they call “continuous coverage” protection, which falls far short of truly protecting people with pre-existing conditions. Here is what they don’t tell you: Continuous coverage protections only ban insurers from discriminating against people with pre-existing conditions so long as people already have insurance and have been insured for multiple years.   

This is a huge difference from what people have now. In most replacement proposals, this continuous coverage protection would allow insurers to discriminate against anyone who went uninsured for just over three months any time over a three-year period. 

If you fall in this category, insurers could: 

  • Deny you coverage all together.
  • Charge you exorbitantly higher premiums based on any health conditions you have.
  • Refuse to cover treatment tied to a pre-existing condition. 

In a nutshell, you’d be left out in the cold with no way to purchase affordable comprehensive coverage for the foreseeable future. 

And it is easy to imagine a host of scenarios where personal or financial hardships could force someone to go uninsured for such a short period of time. Here are some examples of how people’s insurance would lapse:

  • People who lose their job may not be able to afford coverage for the handful of months that they are unemployed. 
  • Individuals caring for a sick family member may not be able to afford to cover themselves while struggling to pay for their loved one’s treatment.
  • Families facing a home foreclosure may be forced to go uninsured while they deal with this financial hardship.

So-called “continuous coverage” protection is not a real substitute for the life-long protection against discrimination that people have now. Instead continuous coverage provisions expose anyone who faces short-term hardships to the risk of being discriminated against and being denied coverage by insurers.  

Republican replacement plans would eliminate coverage requirements that make sure plans cover the care people need 

On top of eroding these core protections against discrimination, Republican plans get rid of critical health insurance standards that ensure that health plans actually cover services commonly needed by people with chronic conditions.

Prior to the ACA, plans could simply decide not to cover certain services like mental health and substance use disorder treatment, or prescriptions drugs. In fact, before the ACA one in three people with coverage in the individual market didn’t have any coverage for substance use treatment. And close to one in five had no coverage for mental health care. Some didn’t even have coverage for prescription drugs. This effectively left coverage useless for anyone that needed this type of care, and often was used by plans to avoid covering people with chronic health conditions.  

Today, plans are required to cover all of these types of care, as well as other core benefits, including hospital care, rehabilitative care, and maternity care. Eliminating this requirement will just open the door for insurers to once again cherry-pick the benefits they cover to detract people who need care.

Despite their rhetoric, Republicans have not shown the American people any proposal that fully protects the 129 million people with pre-existing conditions from once again being discriminated against by insurers.

Nor have they shown us how they plan to make sure that health plans offer truly comprehensive coverage--not coverage that is riddled with benefit exclusions, leaving it meaningless to people who actually need care. And their plans jeopardize current guarantees that insurers will never be able to charge them exorbitantly high premiums based on a health condition.

When it comes to health care, Republicans talk a good game but their actual plans will harm millions of people in America, especially those with pre-existing conditions.

Contact your senators and let them know your concerns about the rush to repeal the health law.