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What Trumpcare Would Mean for Pre-Existing Conditions

Meredith Miller | Published: June 14, 2018

Pregnancy ultrasound

The Trumpcare health plan is an attempt by Republicans to repeal and replace key sections of the Affordable Care Act (ACA), also known as Obamacare. One of many important changes the plan would make affects how easy it is for people with pre-existing conditions to get health insurance. The list of Trumpcare pre-existing conditions is extensive and would increase healthcare costs for 130 million Americans, according to some reports.

What Is A Pre-Existing Condition?

The Department of Health and Human Services (HHS) defines a pre-existing condition as a health problem you have before your health insurance coverage takes effect. This definition is vague and can include almost anything, from acne to cancer. In practice, insurers typically only give consideration to health conditions that come with long-term management, high medical expenses, and/or a risk of complications.

If the Trumpcare plan passes, Trumpcare pre-existing conditions would be determined by each state and health insurance company.

Pre-Existing Conditions Under Trumpcare: Important Changes To Understand

Before the Affordable Care Act, insurance companies were legally allowed to discriminate against consumers based on their medical history and current health problems. People with common health issues like high blood pressure, asthma, and diabetes were charged higher premiums for coverage. People who had a history of serious health problems like a heart attack or cancer were routinely denied coverage completely.

Any number of conditions, from high blood pressure or sleep apnea to asthma, in the past could have gotten someone denied from some insurance companies but accepted by others at a higher premium.

Treatment Of Pre-Existing Conditions Under Trumpcare

The Trumpcare plan, officially called the American Health Care Act (AHCA), rolls back the protection that the ACA put in place. Under the AHCA, states can allow insurance companies to charge people with pre-existing conditions more for a healthcare plan if the states meet requirements like setting up a high-risk insurance pool. While insurance companies would still be prohibited from denying coverage outright, premiums can be raised high enough to force people out of the market entirely.

The bill does seem designed to give an intention of protecting people with pre-existing conditions, but the exact wording of the Trumpcare bill only requires that states explain how they “shall maintain access to adequate and affordable" coverage for people with pre-existing conditions in their application to allow insurance providers to charge more. There is no mechanism to actually require states to take any action or comply with their plans. There is also no requirement under this Trumpcare pre-existing conditions clause that requires the plan to be reasonable or actually work.

Higher Premiums For Pre-Existing Conditions

An AARP report found that premiums under the AHCA could reach $25,700 per year ($2,141 per month) for people in high-risk pools who are expected to have high healthcare costs. The report found that the government subsidies paid to states who set up high-risk pools would not be close enough to offset the costs.

A second report by the Center for American Progress found that premiums could be even higher for very serious conditions. This report found that Trumpcare pre-existing conditions like metastatic cancer could result in charges of more than $142,000 by some insurers for coverage, an increase of 3,500%.

If Trumpcare becomes law, insurance companies may not be able to deny coverage for pre-existing conditions, but the point becomes moot if coverage is cost-prohibitive. Most families will be unable to afford premiums that can top $2,000 per month due to Trumpcare pre-existing conditions.

Along with being cost-prohibitive, plans offered in high-risk pools before the ACA were also less comprehensive than coverage for other consumers. This meant people with a pre-existing condition like diabetes paid significantly more for health insurance that offered worse coverage.

What Do Trumpcare Pre-Existing Conditions Mean For You?

If you have a pre-existing health condition, you will likely be affected in some way. People who get healthcare coverage through their employer would not be majorly affected by this change unless they transition to the individual insurance market, such as through job loss. Still, people with employer-sponsored health insurance will likely pay higher out-of-pocket expenses in the case of a serious illness. This is because the AHCA contains a little-known provision that threatens out-of-pocket limits for catastrophic illnesses like cancer.

Getting individual health insurance under Trumpcare has a good chance of affecting you through higher premiums. Depending on your health, even a fairly benign pre-existing condition like asthma or acne can result in higher premiums.

Who Has Pre-Existing Conditions Under Trumpcare?

According to the HHS, nearly 50% of all non-elderly adults have at least one pre-existing condition. About 130 million people in the U.S. have a pre-existing condition. The most common include:

  • High blood pressure - 44 million
  • Behavioral health disorders - 45 million
  • High cholesterol - 44 million
  • Asthma and chronic lung conditions - 34 million
  • Osteoarthritis and joint disorders - 34 million

Older adults have much higher rates of pre-existing conditions that can lead to skyrocketing insurance costs under the Trumpcare plan. 75% of adults between 45 and 54 years old have at least one pre-existing health condition. This rate increases to 84% among people between 55 and 64.

Very young people are not immune to health issues, either. About 1 out of every 4 children has a pre-existing health condition and would be affected by eliminating health care protection.

Trumpcare Pre-Existing Conditions: What Will and Won’t Be Covered

Prior to the ACA, a wide variety of common health conditions fell into the pre-existing conditions category, such as pregnancy, alcohol or drug abuse, and mental health disorders. Before the ACA, the Kaiser Family Foundation made a list of what insurance companies considered “declinable medical conditions" and risk factors that could result in higher insurance premiums or a denial of healthcare coverage.

The following are examples of common health conditions that would likely be treated as pre-existing conditions under Trumpcare:

  • AIDS/HIV
  • Alcohol and drug abuse if the patient has been treated recently
  • Alzheimer’s and other forms of dementia
  • Anorexia and bulimia
  • Arthritis
  • Cancer
  • Cerebral palsy
  • Congestive heart failure
  • Coronary artery disease and heart disease
  • Crohn’s disease
  • Diabetes
  • Hepatitis
  • Kidney disease and renal failure
  • Lupus
  • Mental disorders, including anxiety, depression, OCD, schizophrenia, and bipolar disorder
  • Obesity
  • Organ transplant
  • Parkinson’s disease
  • Pregnancy, including fathers expecting a child
  • Sleep apnea
  • Stroke

These Trumpcare pre-existing conditions carry the most risk of being put in a high-risk pool with significantly higher premiums. Even less serious pre-existing conditions under Trumpcare may result in higher premiums:

  • Acid reflux
  • Acne
  • Asthma
  • High cholesterol
  • Hysterectomy
  • Migraines
  • Pacemaker
  • Seizures
  • Ulcers

How the ACA Treats Pre-Existing Health Conditions

Under the ACA, healthcare companies are forbidden from denying coverage or charging higher premiums to you if you have a pre-existing condition. Insurance companies must also cover all “essential benefits" for pre-existing health conditions like laboratory costs, chronic disease management, and outpatient services.