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Wednesday, April 26, 2017

House Republicans Gut Protections for Pre-Existing Conditions in Latest Proposal

Lydia Mitts

Associate Director of Affordability Initiatives

Update 5/5/17: Republicans in the House of Representatives passed the American Health Care Act, as their bill to repeal the Affordable Care Act is called. It now goes to the Senate. Visit our Protect Our Care page for ways to contact members of Congress about this bill.


Republican leaders are not giving up on repealing the Affordable Care Act. This week, media leaked text that modifies the harmful House repeal bill to make it more appealing to conservative Republicans. 

Make no mistake: The proposed changes only make a bad bill worse. 

New proposal takes aim at people with preexisting conditions

The new proposal allows states to seek waivers from enforcing the ACA’s core protections for people with pre-existing conditions for almost any reason a state claims. Under this harmful amendment, states could: 

  • Allow insurers to charge people higher premiums based on pre-existing conditions for a full year if they have a small gap in coverage. States could allow insurers to begin doing this as soon as 2018 for people seeking coverage through a special enrollment period. 
  • Eliminate or weaken the law’s essential health benefits requirement starting for plans sold in 2020. The essential health benefit requirement guarantees coverage for services like mental health care, prescription drugs, and maternity care. 
  • Beginning in January 1, 2018, allow insurers to charge older adults even higher premiums than the original House repeal bill. The insurer practice of charging different rates based on age is known as “age rating.” The original House repeal bill increased the maximum "age rated" premium for older adults to 5 times that of younger people. This amendment allows states to go beyond this and allow insurers to charge older people premiums that are even more than 5 times that of younger people. 

To get approval from the federal government for any of the preceding changes, the new amendment does not ask much of states. For example, states that pursue these waivers are not required to guarantee coverage for people with pre-existing conditions at all. 

And states could qualify for these waivers simply by participating in a program that reimburses insurers for expensive claims from high-cost individuals (what Republicans are calling an “invisible high risk pool”). However, such a program offers no guarantee that insurers will actually make coverage affordable to these people with expensive health conditions. 

Worse, under these waivers, there is no limit on how much more insurers could charge people with pre-existing conditions who face a gap in coverage, meaning insurers could effectively price these individuals out of affordable health coverage all together.

Make no mistake, this amendment would return us to the days before the ACA when people with pre-existing conditions were denied affordable and comprehensive health insurance. 

On top of all this, the new amendment prevents states from waiving these protections for health coverage provided to members of Congress and their staff. While Congress is comfortable stripping protections from millions of families, they are simultaneously ensuring that they do not lose any essential health benefits or face higher premiums due to their own health conditions. 

And remember, the new proposal is adding troubling changes to a bill that has been widely criticized for the damage it would cause to our health care system. 

New proposal adds to a repeal bill that is bad for America’s health care

In March, Speaker Ryan gave up on passing the existing version of the American Health Care Act, unable to garner enough votes. Here’s what this disastrous legislation would do:

  • Raise premiums for millions of people in America, especially older and sicker populations
  • Increase the number of people without insurance by 24 million  
  • Effectively eliminate Medicaid expansion and ration future Medicaid care
  • Give $600 billion in tax breaks to the wealthy 

Learn more about the problems with the House bill to repeal the ACA. 

The bottom line? Affordable Care Act repeal would destroy health care

Despite their promises, Republicans in Congress continue to threaten the ACA’s protections for people with pre-existing conditions and its guarantee of affordable coverage. And they continue to put forth proposals that strip coverage from millions and drive up health care costs for millions more. 

Take Action: Urge your representative in Congress to oppose any bill that will increase the number of uninsured, decrease federal protections for people with pre-existing conditions, and cut Medicaid. And tell them it’s time to drop harmful campaign to repeal the ACA. 

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