Donald Trump and other Republicans spent the midterm campaign telling voters that they support protections for people with pre-existing conditions.
Donald Trump at Kentucky rally, October 13, 2018
“And Republicans only will always protect patients with pre-existing conditions. We’re going to protect it.”
This was a flat-out lie.
Recall that prior to the enactment of Obamacare, health insurance companies were able to deny coverage to people with a pre-existing condition, and their definition of a pre-existing condition was rather loose:
Politifact: Pregnancy a ‘pre-existing condition’? Yes, for some
In 39 states, listed here , insurers can turn down anyone for virtually any reason. It can be because you have a pre-existing condition, like cancer or diabetes. And pregnancy almost always counts too, according to the National Association of Insurance Commissioners, which represents the state government officials who regulate insurance sold within their borders. So if you’re pregnant and living in one of these 39 states, you’re very likely out of luck in securing individual health coverage. You’ll have to pay for your care out of your own pocket or seek out charitable assistance.
Obamacare mandated that health insurance companies could no longer deny coverage to people with a pre-existing condition for plans purchased on the Healthcare.gov marketplace, or for Medicaid or CHIP plans.
Healthcare.gov: Coverage for pre-existing conditions
All Marketplace plans must cover treatment for pre-existing medical conditions.
- No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.
- Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health.
- Medicaid and the Children’s Health Insurance Program (CHIP) also can’t refuse to cover you or charge you more because of your pre-existing condition.
These Healthcare.gov marketplace plans are what Republicans have tried repeatedly to kill by repealing Obamacare. Killing these plans and the Obamacare mandates would allow health insurance companies to again deny coverage for people with pre-existing conditions on the individual market. It’s that simple.
In fact, the short-term medical plans that Donald Trump has been hyping as his administration’s “new plans” are not actually new plans at all, and allow health insurance companies to deny coverage for pre-existing conditions.
NY Times: Trump’s Short-Term Health Insurance Policies Quickly Run Into Headwinds
The Trump administration’s efforts to allow health insurers to market short-term medical plans as a cheap alternative to the Affordable Care Act are already running into headwinds, with state insurance regulators resisting the sales and state governments moving to restrict them.
State insurance regulators, gathered over the past three days for a meeting of the National Association of Insurance Commissioners, expressed deep concern that short-term plans were being aggressively marketed in ways likely to mislead consumers. Many said the plans, which need not comply with the Affordable Care Act’s coverage mandates, were a poor substitute for comprehensive insurance.
“These are substandard products,” sold on the premise that “junk insurance is better than nothing” for people who cannot afford comprehensive coverage, Troy J. Oechsner, a deputy superintendent at the New York Department of Financial Services, told the insurers.
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Short-term plans do not have to cover prescription drugs, maternity care, mental health services or pre-existing conditions, which must be covered by Affordable Care Act plans.
And now, the Trump administration has issued new guidance to states that allows federal subsidies that were intended to be used only for the Healthcare.gov marketplace plans to now also be able to be used by states for junk short-term medical plans:
Washington Post: New insurance guidelines would undermine rules of the Affordable Care Act
The Trump administration is urging states to tear down pillars of the Affordable Care Act, demolishing a basic rule that federal insurance subsidies can be used only for people buying health plans in marketplaces created under the law.
According to advice issued Thursday by federal health officials, states would be free to redefine the use of those subsidies, which began in 2014. They represent the first help the government ever has offered middle-class consumers to afford monthly premiums for private insurance.
States could allow the subsidies to be used for health plans the administration has been promoting outside the ACA marketplaces that are less expensive because they provide skimpier benefits and fewer consumer protections. In an even more dramatic change, states could let residents with employer-based coverage set up accounts in which they mingle the federal subsidies with health-care funds from their job or personal tax-deferred savings funds to use for premiums or other medical expenses.
There are serious questions about the legality of these new guidelines, but the intent is clear: the Trump administration is trying to siphon federal subsidies away from the Healthcare.gov marketplace plans, which mandate coverage for people with pre-existing conditions, and put that money instead into junk short-term medical plans, which do not have to cover pre-existing conditions.
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