Does the GOP's new health care bill still cover pre-existing conditions, as Trump claims?

President Donald Trump remains hopeful that he can deliver on his promise to repeal the Affordable Care Act and replace it with a plan from the Republican Party.

In an interview with CBS’ Face the Nation, Trump argued that the GOP’s health care plan covers pre-existing conditions, despite what news reports have said.

"Pre-existing conditions are in the bill," Trump said April 30. "And I just watched another network than yours, and they were saying, ‘Pre-existing is not covered.’ Pre-existing conditions are in the bill. And I mandate it. I said, ‘Has to be.’ "

Trump was more than likely referring to the most recent version of the GOP health care overhaul, an amendment by U.S. Rep. Tom MacArthur, R-N.J., introduced in late April.

"This bill is much different than it was a little while ago, okay? This bill has evolved," Trump said. "But we have now pre-existing conditions in the bill. We've set up a pool for the pre-existing conditions so that the premiums can be allowed to fall."

When CBS’ John Dickerson pressed Trump on whether everyone with pre-existing conditions would be covered, Trump said, "We actually have a clause that guarantees."

White House spokesman Sean Spicer said at the May 1 news briefing that Trump was referring to the MacArthur amendment and that Trump is ensuring that "coverage of pre-existing conditions is at the core" of the legislation.

But the reality of how the bill addresses pre-existing conditions -- which are health problems patients have before new insurance kicks in -- is much more complicated than Trump makes it sound.

What the amendment says on pre-existing conditions

In March, the Republican’s American Health Care Act died without a vote when Republicans couldn’t agree on the bill designed to replace the Affordable Care Act. Under the new bill, called ACHA, insurers had to cover pre-existing conditions, but they could have charged more for people who are recently uninsured.

The MacArthur amendment would allow states to obtain waivers to some requirements of the Affordable Care Act, including the "essential health benefits" provision that requires maternity care or mental health services.

The amendment has language that appears to protect those with pre-existing conditions stating that "nothing in this Act shall be construed as permitting insurers to limit access to health coverage for individuals with pre-existing conditions."

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But experts say other parts of the amendment suggest that those with pre-existing conditions could struggle to maintain affordable health insurance.

The amendment permits insurers to set premiums based on the "health status" of an individual by looking at their current and past health status and make predictions about how much an individual will use medical care in the future, said Linda Blumberg, senior fellow in the Health Policy Center at the Urban Institute.

That’s where pre-existing conditions could come into play, because it would mean that the costs rise for consumers who are sicker, said Timothy Jost, Washington and Lee University School of Law emeritus professor.

"Health status underwriting is literally charging a higher (possibly much, unaffordably, higher) premium to people with pre-existing conditions," Jost said. "Under the MacArthur amendment, they could not be refused coverage, but insurers could impose high enough premiums that coverage would be unaffordable."

The amendment says that the waiver would allow states to set up a high-risk pool or participate in a new federal invisible risk-sharing program to help states reimburse insurers for covering high-risk consumers.  

"No state may obtain a waiver for health status unless it has taken these efforts to protect those who might be affected," stated a MacArthur press release. "In states with a waiver, individuals who maintain continuous coverage could not be rated based on health status."

That means people who stay insured without any lapses can’t be charged more by insurance companies if they get sick.

But experts said that many low-income people aren’t able to stay covered without breaks,  and that questions remain about the effectiveness of the high-risk pools.

The American Medical Association, which opposes the amendment, said in a statement that it "could make coverage unaffordable for people with pre-existing conditions." The AMA raised questions about whether the high-risk pool would be "sufficient to provide for affordable health insurance or prevent discrimination against individuals with certain high-cost medical conditions."

Our ruling

Trump said of the GOP health care amendment, "Pre-existing conditions are in the bill."

The amendment says that health insurers can’t limit access to coverage for people with pre-existing conditions, but that insurers can charge people more if states agree. In some states, health insurers would be able to charge sicker people more. And experts warn that high-risk pools -- the mechanisms meant to keep premiums lower for sick people -- might not be effective.

Overall, the latest proposal seems to weaken existing protections for people with pre-existing conditions, not strengthen them.

We rate the statement Mostly False.

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2017-05-01 20:27:43 UTC

Politifact

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Mostly False

Says of the GOP health care proposal, "pre-existing conditions are in the bill."

Donald Trump

president

Sunday, April 30, 2017

2017-04-30

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