The American Health Care Act, the GOP's Obamacare replacement plan, passed the House of Representatives on Thursday. What counts as a preexisting condition that could get you denied coverage under the new plan?
The bill raises concerns, especially from patient advocacy groups and physicians, that under the AHCA, people with preexisting conditions will once again find health insurance inaccessible.
Preexisting conditions were a term used by insurance companies before the Affordable Care Act to classify certain diseases or health problems that could deny a person insurance coverage or make their coverage more expensive than those who were considered healthy.
Before the ACA
An estimated 27% of Americans under 65 have health conditions that could leave them uninsurable, according to the Kaiser Family Foundation. Some of the preexisting conditions that insurers declined coverage to before the ACA, according to KFF, included diseases such as diabetes and heart disease, which affects millions of Americans.
These preexisting conditions included:
AIDS/HIV, lupus, alcohol abuse/Drug abuse with recent treatment, Severe mental disorders such as bipolar disorder or an eating disorder, Alzheimer’s/dementia, Multiple sclerosis, Rheumatoid arthritis, fibromyalgia, and other inflammatory joint disease, Muscular dystrophy, cancer, severe obesity, cerebral palsy, organ transplant, congestive heart failure, paraplegia, coronary artery/heart disease, bypass surgery, paralysis, Crohn’s disease/ ulcerative colitis, Parkinson’s disease, chronic obstructive pulmonary disease /emphysema, pending surgery or hospitalization, diabetes mellitus, pneumocystic pneumonia, epilepsy, pregnancy or expectant parent, hemophilia, sleep apnea, hepatitis C, stroke, kidney disease, renal failure, transsexualism.
Other conditions that could make it harder to purchase a health insurance plan included, according to the KFF:
Acne, allergies, anxiety, asthma, basal cell skin cancer (a type of skin cancer that doesn't tend to spread), depression, ear infections, fractures, high cholesterol, hypertension, incontinence, joint injuries, kidney stones, menstrual irregularities, migraine headaches, overweight, restless leg syndrome, tonsillitis, urinary tract infections, varicose veins, and vertigo.
Some insurance plans before the ACA also counted rape and domestic violence as preexisting conditions, though CNN reports some states have banned that practice.
Under the ACA
One of the critical parts of the ACA was prohibiting health insurers from denying coverage or charging more for people with preexisting conditions. That went into effect starting in 2014, and it's still the case.
That means that if you had any of that litany of conditions listed above (let's say asthma), you still could have the same insurance as someone who managed to have a clean bill of heath, and someone who is a cancer survivor, pregnant, or obese.
How preexisting conditions could return
The version of the AHCA that just passed the House includes the MacArthur amendment which can allow states to avoid some of the regulations the ACA imposed. That policy, experts argue, could weaken the regulations around preexisting conditions.
Republicans, on the other hand, argue that the bill protects those with preexisting conditions.
"The amendment is very clear: Under no circumstance can people be denied coverage because of a pre-existing condition," House Speaker Paul Ryan said in a release.
But the difference between being denied coverage and not being able to afford coverage is the gray area that has people concerned.
"The various patchwork solutions offered by lawmakers would still leave the millions of patients we represent, who have serious and chronic health conditions, at risk of not being able to access life-saving treatments and care," a group of 10 patient advocacy organizations said in a release Wednesday.
The bill now has to pass the Senate, and Senate Republicans has signaled potentially scrapping the House's bill and coming up with one of their own.
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