A major union echoed claims Thursday that the Republican healthcare bill would allow states to do away with coverage for preexisting medical conditions. The claim, however, overlooks key aspects of that provision.
The American Health Care Act (AHCA) has faced fierce criticism over its potential impact on the health insurance market. Communications Workers of America (CWA) warned the law would allow states to do away with coverage for individuals with preexisting medical conditions. The claim glosses over what the law really does.
“[It] allows the states to do away with coverage for pre-existing medical conditions, affecting 130 million, or one in every four Americans,” CWA claimed on its website.
President Barack Obama completely overhauled the health insurance industry with the Affordable Care Act (ACA). One major provision in the law prohibited insurance companies from denying coverage based on a preexisting condition. The AHCA keeps that provision but allows states to request a waiver under limited circumstances.
Republican Rep. Tom MacArthur proposed the waivers after an earlier healthcare repeal bill failed March 24. States could request a waiver so that local insurance companies have the ability to setup high-risk pools for people with preexisting conditions. Critics fear the high-risk pools could lead to increased costs which might price individuals with preexisting conditions out of coverage.
The CWA and other critics have neglected to mention that a state waiver doesn’t mean everyone with a preexisting condition will automatically lose coverage. The Washington Post, among other outlets, found an individual with a preexisting condition would first need to have a lapse in health coverage for longer than 63 days.
“Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions,” the bill states.
States also have to meet at least one of several conditions in order to get a waiver. PolitiFact reported states that request a waiver must show how it would help reduce average premiums, increase enrollment, stabilize the market, stabilize premiums for individuals with preexisting conditions, or increase health insurance options.
“No state may obtain a waiver for health status unless it has taken these efforts to protect those who might be affected,” a fact sheet from MacArthur argued. “In states with a waiver, individuals who maintain continuous coverage could not be rated based on health status.”
The Center for American Progress (CAP), a progressive nonprofit, estimated the 130 million figure the union cites. It released a report that found the bill could undo protections for many people with preexisting conditions. The report doesn’t mention states must meet certain conditions, or that individuals need to have a coverage gap.
PolitiFact does point to one potential issue that may leave some low-income individuals without coverage. Many people with limited means aren’t always able to stay covered without breaks. Those individuals could face penalties for having a preexisting condition if they don’t get coverage back in time.
The ACA provision protecting people with preexisting conditions became a major point of contention throughout the last administration. Supporters argue it was a necessary policy to protect all Americans regardless of health or financial status. Critics warned it would destabilize high-risk markets and increase prices.
Republicans were originally opposed to mandating that insurance companies had to cover people with preexisting conditions. They are now looking to uphold that provision with the hope the addition of state waivers will help mitigate issues in high-risk markets.
The CWA also claims the bill would cause 24 million people to lose coverage based on a review from the Congressional Budget Office. The review, however, looked at the earlier version of the bill and not its current form. A review of the latest version has not yet been released.
MacArthur proposed his amendment to help the replacement bill actually pass. The earlier replacement bill included a provision which required participants to have continuous coverage or face a 30 percent increase in rates over one year. Republican leadership failed to keep the party united and the bill failed to get enough support.
The conservative House Freedom Caucus became one of the primary opponents. It was a major reason why congressional leaders failed to get enough support. The caucus later said that they do support the addition of the MacArthur amendment in the latest replacement bill.
PolitiFact also reports that states can request a waiver that would allow them to participate in a risk-sharing program with the federal government. Both waivers are intended to avoid issues that could potentially arise in high-risk markets.
The final version of the bill is also likely to look little like the one that is currently being considered. House Republicans were barely able to pass it May 4. The Senate looks even more hostile which has led many to speculate the bill will be radically changed. Lawmakers would then have to go to a conference committee to ensure both bills are identical.
The CWA did not respond to a request for comment by InsideSources.