The treatment of pre-existing conditions has emerged as one of the thorniest issues in health care, which dominated the final debate in the special election to fill Georgia's 6th Congressional District seat.
Democrat Jon Ossoff said the House Republican’s American Health Care Act, “guts protections against massive price hikes for Georgians with pre-existing conditions.”
Both the existing Affordable Care Act and the proposed American Health Care Act require insurance companies to sell everyone a plan who wants to buy it. The rules under the two approaches are different, however.
Both say carriers can’t base rates on a person’s health status but the American Health Care Act lets states get a waiver that allows companies to charge more for people with higher health care risks who have a break in their insurance coverage.
The GOP's health care bill allows states to use two approaches that could affect people with pre-existing conditions. States could let insurance companies base rates on a person's health status, and they could trim the list of health services every plan must offer. The Affordable Care Act requires 10 basic services including maternity care and mental health treatment. Those two are mentioned often as being at risk if states decide to trim the list.
The bill sets aside $8 billion that states with waivers could use in a number of ways. They could use some of it to help cover the costs of high-risk people. There would be additional billions for all states to write down the costs of maternity and mental health care.
No one can say for sure how this would play out.
The Congressional Budget Office, the nonpartisan analytic arm of Congress, estimated that one-sixth of Americans would live in states that chose both to trim the required health services and to let insurers charge sicker people more. In those places, the CBO said "less healthy people would face extremely high premiums, despite the additional funding that would be available."
“Over time, it would become more difficult for less healthy people (including people with pre-existing medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly,” the CBO said.
Health policy analyst Joe Antos at the American Enterprise Institute, a market-oriented think tank, said no one knows which states would ask for waivers, much less whether Georgia would. Also unknown is how states would change the rules for insurance companies.
But even if states let companies charge higher rates for people with pre-existing conditions who let their coverage lapse, he said the maximum number of people who would be adversely affected would be relatively small.
“If they have insurance, they will try to keep it, because they know exactly that they will be big spenders and they want someone else to pay for it,” Antos said.
Antos said there’s a “distinct possibility” some people would face higher costs, but political pressure would limit how far states would go.
Another mitigating actor is the billions of dollars in the American Health Care Act for states to set up high-risk pools. That money would move the most expensive patients off the private insurance rolls. Gail Wilensky, a top health care adviser to President George H.W. Bush, said that with enough funding, this could give such people better care than they get today.
But Wilensky doesn’t think the current bill has set aside enough money.
“Protections are greater under the Affordable Care Act,” Wilensky said. “That’s why it costs as much as it does.”
Our ruling
No expert we reached said the proposed American Health Care Act insulates people from higher rates as much as the current Affordable Care Act does. They differed on the scale of the impact. Ossoff pushed too far on the specifics for Georgia.
We rate this claim HalfTrue.
The House Republican health care bill “guts protections against massive price hikes for Georgians with pre-existing conditions.”
— Jon Ossoff on Thursday, June 8th, 2017 in a debate
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