Ever since President Trump first announced his campaign for president over two years ago, health care reform was at the top of a long list of promises. Specifically, he repeatedly vowed to repeal the Affordable Care Act (ACA) also known as Obamacare and replace it with a plan he felt would be more beneficial to American citizens. For some time, many have been unclear as to how he would accomplish this as the specifics of what would change were not clearly defined. With the introduction of the American Health Care Act (AHCA), Congress finally gives Americans those specifics and now are on the cusp of that promised change’s potential fulfillment.

Changes to Pre-Existing Condition Treatment Under the ACA

One of the landmark changes that the ACA brought to the American health care system was the end of coverage preclusion for those with pre-existing conditions. Before the ACA, insurance companies were allowed to charge those with pre-existing conditions rates that were exponentially more than their healthy counterparts. They also were allowed to deny insured solely based on the fact that they had a pre-existing condition. With the repeal of the ACA, citizens have been understandably concerned about the fate of those with pre-existing conditions in the health care industry. To fully explore, how the AHCA will affect those with pre-existing conditions we will take a look at how the law treated pre-existing conditions before the ACA, after the ACA, and with the proposed AHCA.

Before the American Care Act, the decision about pre-existing conditions fell mostly to the insurance companies’ judgment. Firstly, health insurance companies were allowed to decide for themselves what was considered a pre-existing condition. Pre-existing conditions included things such as arthritis, obesity, heart disease, anxiety, depression, and many other common conditions. By the standards used before the ACA, currently, 27% of Americans have pre-existing conditions. It was also up to each carrier to determine how much they would surcharge for said pre-existing condition, and whether or not they would deny coverage to someone with a pre-existing condition. Allowing carriers to deny coverage on these basis’ left many people uninsured – finding it impossible to find coverage or unfeasible as they just could not afford the exorbitant premiums.

Once President Obama enacted the ACA, things changed drastically. Insurance companies were no longer allowed to deny coverage to those with pre-existing conditions. Nor were they permitted to charge more to those with pre-existing conditions. The ability of those who had previously been denied coverage or priced out of coverage to purchase insurance at a reasonable price caused an influx of insurance purchases. Unfortunately, it also caused an increase in the number of health insurance claims due to those with pre-existing conditions and the sign-up of healthy people to counteract this was not as high as expected. As an unfortunate factor of the jump in claims, insurance prices went up across the board for everyone in 2017.

Initial Treatment of Pre-Existing Conditions under the AHCA

The American Health Care Act (AHCA), which is also known as Trumpcare, Ryancare (after Representative Paul Ryan), and Republicare, was first released to the public on March 6, 2017. When first proposed, the AHCA offered the same treatment of those with pre-existing conditions as the ACA. Those with pre-existing conditions would not see a rate increase nor would insurance companies be allowed to deny them coverage. The main proponent of the AHCA that supporters say make it superior to Obamacare is the end of the insurance mandate. If the bill passes, American citizens will no longer be required to purchase health insurance, and the government will not penalize them if they choose not to. The proposal allows for carriers to charge a surcharge for up to 1 year for anyone who has had a lapse in insurance for more than 63 days to counteract the possibility of people then only buying insurance when they get sick.  The allowed surcharge is up to 30% of the individual’s premium. Even with these drastic changes, some opponents of the ACA felt that the AHCA was too similar to it and wanted all factors of the ACA repealed.

Treatment of Pre-Existing Conditions under the MacArthur Amendment

To appease those against Obamacare, Congress introduced an amendment to the AHCA. These changes, drafted by Representative Tom McArthur (R-NJ) and known as the MacArthur amendment, would allow insurance states to seek a waiver from the companies to charge those with pre-existing conditions more in certain situations.  For them to meet these conditions, an insured must have let their existing insurance lapse.  Then, only if the state in which they reside has applied for and received a waiver from the federal government may the insurance companies charge them more than their healthy counterparts. However, as we have already seen Trumpcare would already allow companies to surcharge anyone who has a lapse in health insurance of more than 63 days. This facet is not too different from property and casualty insurance where insurance companies charge those with lapses in coverage more than their counterparts that have had continuous coverage.

One thing about that the ACA and the AHCA seem to have in common when it comes to pre-existing conditions is that neither permits insurance companies to deny coverage based off of pre-existing conditions.  When it comes down to it, the ones that would be most affected by this bill, if it is to pass, regarding pre-existing conditions are those who let have purchased health insurance through the marketplace, have a pre-existing, and let their insurance lapse. Even then, it is all up to your state and whether or not they have a waiver. Unfortunately, there still seems to be much division over what is best for our country regarding health care as some feel this bill has only moved further away from the goal and others argue that it is still not far enough.

The proposal was brought to the house and passed by a narrow margin of 217 to 213 on May 4th. Next, the bill will make its way to the Senate voting floor. However, Senators say that they will have their own changes to make to the bill before it is ready to make it to the voting floor. Whether you are for or against the bill, one thing is certain, if this bill passes health care in America will be flipped on its head.