Trump’s flirting with pre-existing conditions coverage took off over the summer, after the House Republican health care bill was narrowly rejected by a House committee last month. Some supporters of the bill said it would include language to help expand coverage for Americans with pre-existing conditions.
But even before the vote, Trump had endorsed a more rigorous version of pre-existing conditions coverage, signaling that he and congressional Republicans saw the path to passage as paved by those with preexisting conditions themselves.
“I think they make a lot of sense,” Trump said of a pre-existing conditions measure in a presidential radio address last December. “We’ll see.”
That proposed amendment would have lifted the federal ban on health insurance plans that offered non-essential benefits like maternity care that don’t currently have to cover medical care or counseling for people with pre-existing conditions. These benefits would be unavailable for plans that don’t cover comprehensive services because they would be deemed “unaffordable.” At least eight states, mostly Republican, already have such laws.
Insurance companies that still offer these insurance plans could charge higher premiums and provide lower coverage than what insurers currently do for people who are sick, according to a White House official. That could have allowed for discrimination against those already having serious medical conditions. The official said the Trump administration expected pre-existing conditions protections to be in the bill before it would pass the House and is open to considering this exact language in a future bill.
Trump’s White House office would not disclose a draft text of the legislation.
The proposal, which critics of the ACA feared could make it easier for people with pre-existing conditions to get insurance, did not include the mandate that requires most Americans to carry health insurance, as does the bill approved by the House panel. Many right-leaning activists fear Trump’s health care plan would allow some people to get cheaper coverage and maintain coverage for conditions.
Their concern likely found its footing when, on the eve of Trump’s bill vote in the House, the CEO of MetLife warned that the President’s health care legislation would make insurance less affordable and could set back the fight against rising health care costs.
The actual language of the proposal from the House committee seems unlikely to affect the entire insurance market. The measure — which became known as the Better Care Reconciliation Act of 2017 — did not include language on pre-existing conditions protection because it was opposed by groups including the American Hospital Association and the Leukemia & Lymphoma Society. Many experts say the Department of Health and Human Services likely will not need to do much to enforce a new law that makes it illegal to discriminate against health care customers. The ACA did not include a ban on discrimination against people who are sick.
Few people actually benefit from the former Republican measure. According to the Commonwealth Fund, fewer than 10 percent of people with pre-existing conditions pay more than 5 percent of their income on health insurance premiums and so cannot get private health insurance. People who were denied coverage in the past are less likely to gain coverage because state law requires them to follow the same rules to get a new plan. For instance, Colorado recently extended its preexisting conditions law to cover more people and expanded its eligibility. People who were denied coverage in the past are less likely to gain coverage because state law requires them to follow the same rules to get a new plan.
How many people in the U.S. would gain coverage? This is unclear, but it appears that the majority of Americans would not gain coverage. The White House official said the ACA covers more people but would not specify what its plan would cover in ways not included in the ACA, which was passed in 2010 after an effort by former President Barack Obama to expand coverage to tens of millions of uninsured Americans.
Even some supporters of the GOP plan are doubtful pre-existing conditions would play much of a role in the long-term future of the bill.
“In the long term, I think this can’t be sustained,” said Tom Scully, a former associate director of the Centers for Medicare and Medicaid Services under President George W. Bush. “For every bad piece of legislation that ends up getting passed that ends up costing more money over the long term, there’s going to be a good piece of legislation that comes along that’s a reasonable addition.”