HOW DID THE ACA ADDRESS PRE-EXISTING CONDITIONS?

  • Mandated all insurers accept all applicants, regardless of health.
  • Mandated insurers couldn’t price new coverage based on health factors.
  • Caused serious problems for insurance markets -> death spiral of the exchange.

    • More costly for people to buy insurance when healthy.
    • Some wait to buy insurance until sick.

LET’S DISPEL THE MISINFORMATION ABOUT HOW REPEAL AND REPLACE MIGHT AFFECT PEOPLE WITH PRE-EXISTING CONDITIONS:

  • No one will be denied coverage for any reason.
  • In all 50 states, premiums will NOT increase for costly health conditions if continuously covered.
  • Protection programs for pre-existing conditions seeking coverage.

HOW WILL REPEAL AND REPLACE PROTECT PEOPLE WITH PRE-EXISTING CONDITIONS?

  • No one will be denied insurance coverage for any reason.
  • States can waive some of the law’s other costly regulations.
  • Must guarantee affordable coverage for all or waiver void.

 

DISPELLING MISINFORMATION

 

MISPERCEPTION: Many are confused about what a pre-existing condition is. Scare ads use an overly broad definition and try to mislead people to believe any health condition would result in the loss of health coverage.

FACT: In reality, insurance companies define pre-existing conditions much more narrowly. Even though “pre-existing” literally means the condition developed before an applicant sought a new insurance plan, that doesn’t mean every condition would result in the insurance industry denying coverage. Even absent government regulations, insurers did and would cover people with a wide array of health problems, including common problems like managed high blood pressure, high cholesterol, or acne.

MISPERCEPTION: People with pre-existing conditions will be denied coverage.

FACT: This is NOT true. No one will be denied coverage for any reason.

MISPERCEPTION: People with costly conditions will face unaffordable premiums.

FACT: The repeal-and-replace plan includes protections against this.

  • Where have continuous coverage, all 50 states: premiums will not increase because of health condition.
  • (Specific to American Health Care Act) In waiver states, where coverage gap of more than 2 months (63 days):

    • Premiums may reflect health condition temporarily (up to one year), but get help if costs high.
    • Waiver states required to offer you guaranteed, affordable coverage in a special program if premium offered is too high.

MISPERCEPTION: People with pre-existing conditions will be unable to be insured affordably.

FACT: Waiver states MUST demonstrate that their special protection programs for pre- existing conditions are working to provide guaranteed, affordable coverage.

 

ONE WAY TO DO THAT IS THROUGH A GUARANTEED PROTECTION PROGRAM 

Guaranteed protection programs can and did work well.

  • Pre-ACA 35 states had guaranteed protection programs:

    • Not perfect
    • Much better than the ACA
    • Intended to offer coverage when denied in the private market
    • Capped premiums at approximately 150% of standard rates
    • Deductibles / out-of-pocket costs more affordable than with ACA
    • Some states offered subsidies to low-income people
  • Guaranteed protection programs allow for freer, more functional insurance markets:

    • Nearly 90% of applicants accepted for regular coverage at regular rates
    • More options, lower rates than in states without guaranteed protection programs
    • Encourages people to apply when healthy, before sick
    • No need for a mandate, fine, or annual enrollment period
  • Going Forward:

    • MUST ensure that states have the resources they need
    • Waivers VOID if states fail to guarantee access to affordable coverage
    • If choose to use guaranteed protection program, MUST ensure works well

How will repeal and replace protect people with pre-existing conditions?

  • No one will be denied insurance coverage for any reason.
  • (Specific to American Health Care Act) In waiver states:

    • Free to reduce insurance premiums for all, especially the healthy, allows return to pre-ACA choices, lower costs
    • Can counteract death spiral in insurance markets by encouraging people to get and stay insured when healthy, before sick
    • Will not see higher premiums for those with conditions who stay continuously covered
    • Even for those who wait to buy coverage until sick, there are time limits on how long insurers can charge them more than healthy applicants
    • MUST demonstrate guaranteed, affordable coverage for all through guaranteed protection programs for pre-existing conditions
  • In all 50 states, premiums will NOT increase for costly health conditions if continuously covered, and costs should decline for those without what insurance companies think of as pre-existing conditions.