How to Fact Check Candidates’ Claims on Preexisting Conditions

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In the coming medium-term periods of 2018, health will be the most important issue for voters , with the continued protection of people with pre-existing medical conditions at the center of attention.

Because of this, politicians stumble upon demanding support to cover people with pre-existing medical conditions, a provision of the Affordable Care Act, which is possibly the reason the law was not successfully repealed by Republicans last year (this is the most popular part of the. health).

When both Democrats and Republicans claim to be the party that will keep health coverage for the most vulnerable, who should you trust?

What are the existing conditions?

Preexisting conditions are any medical conditions, illnesses, or chronic conditions that someone had before or during their attempt to buy insurance. For our purposes, we are talking about achieving insurance coverage in the individual insurance market (not through an employer), and this process has been substantially revised by the Affordable Care Act.

In the past, insurance companies have used any illness or ailment to drop insurance coverage altogether or to dramatically increase prices. Fifty-two million adults under the age of 65, or 27 percent of this population, “have preexisting health conditions that are likely to make them uninsured if they apply for health insurance in accordance with health insurance practices that existed in most states. before making changes to the insurance rules. The Affordable Care Act, ”says the Kaiser Family Foundation , and this is a conservative estimate.

The reason is that it is not only about diseases such as cancer and diabetes, which can take away your coverage or increase the price of people who are “healthier”, but also:

  • Acid reflux (increased insurance premiums)
  • Acne (increased insurance premiums)
  • Asthma (increase insurance premiums)
  • Epilepsy (Deny coverage)
  • Caesarean section (increased insurance premiums)
  • Celiac disease (increased insurance premiums)
  • Heart disease (deny coverage)
  • High cholesterol (increased insurance premiums)
  • Kidney stones (increased insurance premiums)
  • Knee surgery (premium increase)
  • Mental health problems (eg: bipolar disorder, eating disorder) (deny coverage)
  • Migraine (increased insurance premiums)
  • Pregnancy (Deny coverage)
  • Withdrawals (increase in insurance premiums)
  • Stroke (Denied coverage)
  • Sleep apnea (deny coverage)
  • Transsexualism (refute)
  • Ulcers (premium increase)

Certain drugs and professions – such as law enforcement, security, taxi drivers, etc. – were also rejected. (You can see exactly what the insurers were looking for in this old app .)

The effect of this meant that many people were left without insurance coverage – the KFF estimates that 18 percent of individual market applicants were denied a preliminary ACA, which, again, is a conservative estimate as many people with conditions did not bother to apply at all. “Insurers have named premiums 50 percent higher for depression and 100 percent higher for breast cancer,” the Center for American Progress said in a report . “And one underwriting guide has shown that simple weight gain results in a 25 percent increase in premiums on some plans.”

The report also estimates that even people with mild illnesses will pay thousands more than other people to get coverage.

For example, since a person with asthma costs the issuer 106 percent more than a healthy 40-year-old person, they will face an additional insurance premium of $ 4,340. The co-pay for diabetes will be $ 5,600 per year. Insurance can become prohibitively expensive for those in dire medical need: insurers will charge about $ 17,320 more in pregnancy premiums, $ 26,580 more for rheumatoid arthritis and other autoimmune diseases, and $ 142,650 more for patients with metastatic disease. cancer.

Protection against pre-existing conditions exists thanks to the ACA

Before the ACA, insurers in the individual market could deny insurance to people with pre-existing conditions, provide coverage related to their conditions, or inflate prices so that people could not afford it anyway. The ACA, which came into force mainly in 2010 and 2011, banned this practice, as well as price estimates by sex and age (older people are charged significantly more than young people, and women are usually charged more than men) …

Health insurance for people with employer insurance is largely regulated by ERISA, not ACA, and large employers cannot deny insurance to their employees based on their medical history. However, there are some parts of the ACA that even apply to employer plans, including the nuance of covering pre-existing conditions, which we wrote about earlier :

Before the ACA, your employer’s plan could not deny coverage or charge you an additional fee, but it could exclude coverage for your preexisting conditions for a year if you do not maintain continuous coverage. This is where the plans will return if the ACA regulations are lifted. (Plans for large and small groups can lead to worse results.)

It’s possible that the ACA could be repealed and a subsequent law passed to protect coverage for people with pre-existing medical conditions, but the current cancellation of the ACA means the American health care system will revert to what it was before 2010: insurance coverage, sky-high prices for people who have fallen ill or have had an illness, more expensive coverage for women, etc.

20 Republican legislatures sue to overturn ACA

Currently, 20 states, led by Republican legislatures, are suing the federal government to terminate the ACA, in particular to defend pre-existing conditions (likely because a previous lawsuit to invalidate one component of the law – the individual mandate – was successful). The Trump administration has refused to defend the law in court. If successful, “52 million Americans with pre-existing medical conditions could lose coverage, face higher premiums, or be locked out of current coverage,” Reuters reported.

What’s more, House Whip Steve Scalise and Senate Majority Mitch McConnell have pledged to return to cancellation after the midterm elections.

And all Republican Congressmen – with the exception of Senators Susan Collins, John McCain and Lisa Murkowski, and 20 Republicans in the House of Representatives – voted to repeal the ACA last year. Canceling ACA means canceling protection for people with pre-existing medical conditions. President Trump tweeted: “All Republicans support the people in a pre-existing environment, and if they don’t, they will after I speak to them. I fully support it. ”This is clearly a false statement. Firstly, because, as you can see above, Republicans are actively trying to undo the protection, and secondly, because Trump himself is in favor of gutting the ACA .

Some of these politicians say they support health measures.

Spin is okay in politics, but it seems that some politicians are outright lying about health issues, about their track record. Here are politicians currently running for office making suspicious claims that they will defend health care, including:

Margo Sanger-Katz of the New York Times released more details on other questionable advertisements.

In August, 10 Republican senators presented their plan to theoretically fill the existing coverage gap. The Law on Insurance of Preexisting Conditions states that insurers cannot base their eligibility for insurance on the basis of health conditions or medical history. However, things are not as simple as the Polittifact explains :

The bill adds the option for companies to deny certain coverage if “they are unable to provide services appropriately.”

For Allison Hoffman, a law professor at the University of Pennsylvania, this is a big loophole.

“Insurers can exclude pre-existing conditions from coverage even if they offer her a policy,” Hoffman said. “This fact in itself refutes any claims that this law offers protection for pre-existing conditions.”

The only Republican Congressman who has consistently opposed the repeal of the ACA is Senator Susan Collins from Maine. The fact that the GOP now sees that it has polling problems due to its attempts to repeal the law – it turns out that people really enjoy access to health care – means that they are distorting the truth to fit their current political needs.

As Sanger-Katz wrote on Twitter : “It’s hard to understand what is in people’s hearts. But most Republicans in Congress voted on bills last year that would significantly weaken the current protection of people with pre-existing conditions. ” This is a fact regardless of what the ad says.

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