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What You Need to Know: Trump Healthcare and Pre-Existing Conditions...

If you're like me as an HR pro, you've always had your eye on the pre-existing condition angle of any healthcare legislation.  That was a priority before Obamacare, became less of a priority during Obamacare (and a relief) and has now become ugly as a the GOP presents the American Health Care Act (AHCA), the new Republican bill to replace the Affordable Care Act (a.k.a. Obamacare).

There's been a lot of claims related to how many pre-existing conditions won't be covered, specifically related to the explosive issue of victims of domestic violence and more.

Admittedly, I like the Obamacare provision of no BS when it comes to pre-existing conditions. Its a high empathy provision and feels right.

But with the AHCA bearing down on us, I started to really try to go beyond the clickbait headlines most were serving up on pre-existing conditions and find out what bill actually provides and says.  I wanted to know this for myself (because I know that gaps in coverage are bad any time pre-existing conditions are a part of the mix) since I find myself giving advice to friends and previous employees based on what I do for a living.

Let me tell you - finding a factual account of what the bill actually says is hard in a world where Facebook serves you up more of whatever you click on (imagine echo chamber sound effect as you read that sentence - for both sides of the political aisle).

Here's the best reporting I could find on how pre-existing conditions might be considered/changing if the GOP bill gets through the Senate, courtesy of the Washington Post

The revised GOP plan included an amendment crafted by Rep. Tom McArthur (R-N.J.), which helped the plan attract votes that led to its passage. The amendment allowed states to seek waivers from a “continuous coverage” provision that otherwise would boost insurance rates by 30 percent for one year if a person has a lapse in insurance coverage for more than two months.

Instead, if the state met certain conditions, insurance companies for one year could consider a person’s health status when writing policies in the individual market. Another possible waiver would allow the state to replace a federal essential benefits package with a more narrowly tailored package of benefits, limited to the individual and small-group markets.

These changes would affect a specific group of people who meet the following criteria: Lives in a state that seeks this waiver; has a lapse in health coverage for longer than 63 days; has a preexisting condition; and purchases insurance on the individual or small-group market.

A person who fell into this category would face insurance rates that could be based on their individual condition, for one year. (States that seek a waiver would need to provide ways to help make up the difference in costs.) After that, people would qualify for prices at the community rate, rather than based on their individual conditions. This would not affect people with employer-funded health coverage; the individual market, including the Obamacare exchanges, currently serves about 18 million Americans.

Here's how I'll read that to help the people who ask me how to interpret pre-existing conditions should the AHCA pass:

  • It sounds like in some states, there may be a year-long period where you could get hurt financially related to pre-existing conditions.  Not all states, but some for sure.
  • You'll be better off if you have pre-existing conditions in your family by working for an employer rather than yourself during this period.
  • If you work for an employer, it's probably best if you have a potential pre-existing tab at risk to hunker down and not change insurance during the referenced one-year period.
  • I'm assuming COBRA is still an option, which would allow most exiting companies to get through the 1-year period at employer market rates.
  • I'm unclear if insurers will be able to cancel existing individuals polices during the one-year period.  I'm assuming no, but I haven't seen that clearly stated by anyone doing responsible analysis.

So that's my report.  I'm turning more and more to the Washington Post for responsible reporting.  I find them to be hard on the far-right but fact based when reporting on issues like the AHCA. 

HR pros - good luck explaining new pre-existing condition issues to your friends, family and employees. 

Comments

MattL

I have libertarian leanings, and I like WaPo. Generally high quality research/reporting. Truth in advertising - I have a friend who is a reporter there. I asked him about Bezos. Here is the quote (somewhat NSFW).

"hey, he saved us. new building, new mission, new bank account,
crazy $$, all that. i assume we'll be the jilted gf at some
point, but for now? we're his bitch & luvin it."

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