Pre-Existing Conditions


How will this affect my family?

The honest answer is, “it’s complicated”. In short, the Graham-Cassidy bill allows states to remove protections for people with pre-existing conditions, allowing insurance companies to charge them higher premiums: the details of this would vary between states. Individuals who could no longer afford insurance coverage would be grouped into high risk pools.  Not only is the funding set aside for high risk pools inadequate, they are not particularly effective for insuring people with pre-existing conditions.

The Details

There are 3 different parts of the AHCA that relate to pre-existing conditions.

  1. Continuous coverage — the prohibition against insurers charging people with pre-exiting conditions more does not apply if a person does not have insurance coverage for more than 2 months.  So if a person loses a job or has some kind of crisis that causes them to lose insurance, even short term, insurers can charge them more.  (The data is that many people with disabilities experience these short gaps in coverage).  This of course could impact people with Down Syndrome and their families.
  2. Waivers of pre-existing condition protections — In order to appease the Freedom Caucus, the AHCA passed by the House includes a provision that would allow states to choose to waive pre-existing condition protections (and essential health benefits requirements).  Of course, families with Down Syndrome could end up living in states that choose to waive pre-existing condition protections.
  3. High risk pools — In order to appease the moderate Republicans who didn’t like the waivers, the AHCA also included some money for high risk pools, with some additional funding for states that choose to waive the pre-existing condition protections.  Analysis of high risk pools shows that they are not particularly effective for insuring people with pre-existing conditions (especially people with higher costs) and that the funding set aside in the AHCA is far short of what would be needed.

Learn More

Vox article on pre-existing conditions

Washington Post Fact Check on Pre-existing conditions

CBPP on the amendments & pre-exiting conditions

Eliminating Federal Protections for People with Health Conditions Would Mean Return to Dysfunctional Pre-ACA Individual Market (Center on Budget and Policy Priorities)

New amendment to GOP health bill effectively allows full elimination of community rating, exposing sick to higher premiums (Brookings Institute)

High Risk Pools Not a Solution

High-Risk Pools: No Solution for People with Pre-existing Conditions [The Century Foundation]

Creation of High-Risk Pools would Imperil the Most Vulnerable Consumers [Consumers Union]

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