The current edition of Trumpcare is pretty awful for people with pre-existing conditions, the Congressional Budget Office’s analysis (the “CBO score”) confirmed this week. But do you know if you have a pre-existing condition? Does sexual assault count as one? Let’s take a look.
This matters because the new health care bill would allow insurers to charge you more because of your health status. Before the ACA, it could be difficult to impossible to buy your own insurance if you had anything but a clean bill of health. Under Trumpcare, it wouldn’t be quite as bad: you only have to worry about pre-existing conditions if you had a gap of two months without insurance and you live in a state that has been granted a waiver allowing it not to comply with the law.
In addition, insurers can’t outright deny you for a pre-existing condition. But they can set their prices so high you can’t afford it. The Center for American Progress estimates that women who have had a baby would be charged $17,060 more per year than people who did not. If you’ve had cancer, your premiums would be somewhere upwards of $140,000 per year. Your premiums.
The Most Important Things They Don’t Want You to Know About the Health Care Bill
Good morning! Remember that health care bill that was so terrible that even the people who…
Fine, you might say, I don’t plan to have a gap in coverage. But remember that for many people, insurance will cost more than it currently does. If you lose your job and can’t afford the COBRA payments, the person with a gap in coverage could very well could be you. (Pre-ACA, it was also common for people who had chronic health conditions to be trapped in bad jobs because they couldn’t risk losing their health insurance.)
According to the new CBO score, one-sixth of the population of this country lives in places where the market could “become unstable” if the new bill becomes law. In other words, in states that request waivers, this scenario is likely to happen:
Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all—despite the additional funding that would be available under H.R. 1628 to help reduce premiums.
So technically insurers have to sell you coverage even if you have a pre-existing condition—but they could end up charging so much you can’t afford it anyway.
Trumpcare Doesn’t Define Pre-Existing Conditions
There’s a sort-of myth that the health care bill defines sexual assault, domestic violence, and previous c-sections—but not erectile dysfunction—as pre-existing conditions. This is technically false: the bill does not contain a list of pre-existing conditions.
The ACA didn’t define pre-existing conditions, either, because it essentially outlawed the concept. Insurers had to set their rates for entire groups of people based on age and smoking status—”community rating”—and couldn’t charge you a different price due to your health status.
The new health care bill removes that provision. If a state asks for a waiver, then insurers in that state can use health status to set premiums again. For young and healthy folks, insurance will be cheap. But as soon as you get some kind of health problem, you’re in trouble. If you ever have a gap in coverage and need to go shopping again, you could find that the price of coverage is astronomical.
A Lot of Us Have Pre-Existing Conditions
It’s not the law that decides what’s a pre-existing condition; it’s the insurance companies themselves. If the CEO of Aetna wakes up one day and decides to hike up costs for people with hangnails or baldness or a history of broken ankles, they totally can. More realistically, insurers hike up costs for people who are more likely to need expensive care in the future.
About a quarter of American adults under 65 have pre-existing conditions that made them “declinable”—you could be denied coverage—before the ACA, according to a report by the Kaiser Family Foundation. In 2015, 6.5 million people had pre-existing conditions and had a gap in their insurance.
The Kaiser Family Foundation also has data on what those pre-existing conditions were. They varied from one insurer to another, but conditions that were commonly on the “declinable” lists include:
- Alcohol abuse/ Drug abuse with recent treatment
- Arthritis (rheumatoid), fibromyalgia, other inflammatory joint disease
- Cancer within some period of time (e.g. 10 years, often other than basal skin cancer)
- Cerebral palsy
- Congestive heart failure
- Coronary artery/heart disease, bypass surgery
- Crohn’s disease/ ulcerative colitis
- Chronic obstructive pulmonary disease (COPD)/emphysema
- Diabetes mellitus
- Hepatitis (Hep C)
- Kidney disease, renal failure
- Mental disorders (severe, e.g. bipolar, eating disorder)
- Multiple sclerosis
- Muscular dystrophy
- Obesity, severe
- Organ transplant
- Parkinson’s Disease
- Pending surgery or hospitalization
- Pneumocystic pneumonia
- Pregnancy or expectant parent
- Sleep apnea
Remember, these are just the most common things on the pre-existing condition lists. Could sexual assault be a pre-existing condition? Maybe, but there’s no evidence this was ever widespread. The same goes for minor ailments like acne and mild cases of depression: could they hike up your rates for those? Sure, and some insurers did. Will they in the future? We don’t know.
To put it another way, the health care bill doesn’t name any conditions that are fair game; but they also don’t explicitly protect any of them, either.
Insurers also used to keep lists of medications that could disqualify you, including meds for HIV, cancer, heart disease, diabetes, and more. There were also declinable occupations, including firefighters, taxi drivers, and our president’s favorite, coal miners. These aren’t likely to be considered pre-existing conditions, although it’s hard to say exactly what will happen with insurance policies under the new law since they haven’t been written yet.
The bill has also not yet become law. It passed the House, but the Senate is now writing their own version. If you have an opinion on what it should include, give your Senator a call.