The Senate’s version of the TrumpCare bill is out, and it’s as monstrous as we thought it would be. In order to give billions of dollars in tax breaks to the wealthy and corporations, it makes the deepest cuts to Medicaid in its 52-year history. Not only does it end the Medicaid expansion, it fundamentally (and permanently) alters Medicaid in a way that threatens the well-being of low-income families across the country.
Another terrible part of the bill is that it ends guaranteed protections critical for people with pre-existing conditions. You may have heard just the opposite—that people with pre-existing conditions are protected, and that this version of TrumpCare is “nicer” or “better” than the House version for that reason. Don’t fall for it. It’s still much worse than current law. And, if you’re one of the 130 million Americans with a pre-existing condition, you could be the one paying the price.
How the Affordable Care Act protected people with pre-existing conditions
The ACA has a provision requiring insurance companies to set premiums rates by “community rating,” which, when translated from wonk to English, means that people with pre-existing conditions can’t be charged more for insurance than those without. It worked.
This provision works hand-in-hand with another ACA protection for consumers, the requirement that all health plans cover “essential health benefits.” This is the menu of different coverage benefits insurers are required to cover, and it includes maternity care, mental health, and prescriptions. If plans aren’t required to cover needed benefits, especially care that people with pre-existing conditions need, it doesn’t matter whether you’re protected from being charged more for plans, because insurance companies can design plans to explicitly deter people with pre-existing conditions from enrolling. “Community rating” doesn’t work unless backed up with “essential health benefits.”
How the Senate version of TrumpCare changes this
The Senate bill allows states to opt-out of covering essential health benefits, which means insurance companies can stop offering plans that cover the kind of services people with pre-existing conditions need. This has the effect of driving up the price for consumers for plans that offer the broader coverage they need, likely to the point where no one could afford it.
In other words, the Senate TrumpCare bill gives insurers a backdoor way of discriminating against people with pre-existing conditions.
How Ted Cruz wants to make this worse
Senator McConnell has a tight needle to thread: he’s trying desperately to recruit “moderate” Republicans that are holding out, but he also needs to keep the extreme wing on board. That’s why he’s pushing a proposal from Ted Cruz that will allow insurance companies to sell plans that have fewer benefits and patient protections as plans currently sold through the marketplace. They’re allowed to do this as long as they sell just one plan that complies with the ACA requirement to cover essential health benefits that people with pre-existing conditions rely on.
What will this mean? People with pre-existing conditions will have no choice but to pay higher costs in order to get the plans that cover the treatment they need. This could also create serious confusion for customers buying through the exchange when trying to understand which plans cover their necessary treatments and which do not.
Don’t believe them when they say people with pre-existing conditions are protected
Here’s the bottom line: under current law, people with pre-existing conditions have guaranteed access to health insurance that covers the care they need. They cannot be discriminated against for having a pre-existing conditions. Under the Senate TrumpCare bill, those protections go away. If affordable plans don’t cover the services someone with pre-existing conditions needs, it doesn’t matter whether they have access to it or not.