Politics & Policy

What the AHCA Really Says about Preexisting Conditions

(Photo: Photographerlondon/Dreamstime)
It’s not what Democrats claim.

As demonstrated by the recent outrage surrounding the passage of the American Health Care Act (AHCA) in the House of Representatives, there is widespread misinformation about what is happening in Washington, D.C., when it comes to the repeal and replacement of the Affordable Care Act. Legislators are largely to blame for the circus: Much of the confusion over what the vote means for access to health care stems from the sharp contrast in language used by the leaders of our major political parties.

Politicians use rhetoric to persuade people to take their point of view, and members of both parties employ scare tactics to misrepresent their opponents’ legislative goals. Debates on health care often bring out the worst of this type of language, with politicians playing on emotions and fear to cause hysteria and prevent people from examining the facts.

In the debate over the AHCA, Democrats felt forced to defend the status quo of Obamacare and repeatedly insisted that individuals with preexisting conditions would no longer be able to purchase insurance, even asserting that women would be charged extra for being victims of domestic violence and sexual assault. These claims could not be further from the truth.

The AHCA preserves the federal standard that no one can be denied coverage for a preexisting condition. This was a requirement for many Republican representatives and has been in every version of the bill since it was originally introduced. The bill also includes “continuous coverage” protections that guarantee no one is charged more than standard rates, regardless of health status, as long as they remain continuously insured.

Safety-net programs for those with preexisting conditions are also built into the legislation. The Patient and State Stability Fund allocates $100 billion to states to help stabilize their individual markets; this will lower costs and increase access for patients. The Invisible Risk Sharing Program provides an additional $15 billion to help insurance companies cover high-cost enrollees, and the final AHCA amendment’s sole purpose was to provide another $8 billion to help those with preexisting conditions.

The controversy surrounding preexisting conditions has its origin in a provision in another amendment that allows states to obtain waivers from certain federal standards on a limited basis. The vast majority of people purchasing health insurance will not be affected by this provision. For those acquiring coverage through their employer, Medicaid, Medicare, or the VA, medical underwriting remains prohibited. Those covered through the individual market will be affected only if they live in a state that is granted a waiver, and states can obtain a waiver only if they prove it is necessary to improve the state insurance market as a whole, bringing down costs or increasing coverage. States that seek a waiver must also set up an additional layer of protection for consumers in the form of high-risk pools to ensure subsidized funding to pay for premiums.

It’s tempting for conservative lawmakers to put their heads down and proceed with blinders on, but Republicans need to get better at making their case to the American people.

This narrows down those potentially affected by the legislation to a very small percentage of Americans. And again, even someone who has a preexisting condition, lives in a waiver state, and seeks coverage in the individual market can be charged more only if they have failed to maintain continuous coverage, letting their policy lapse for longer than 63 days. Even then, the increased premium can be charged only for one year, and the increased costs will be offset by the required subsidized funding.

To be sure, the lack of transparency in Republicans’ introduction of the legislation contributed to the spread of misinformation. Republican leadership should have set appropriate and realistic expectations for the public before embarking on the repeal process. Speaker Ryan billed the vote as a rescue mission to save the imploding health-care system, but the rushed rollout, the lack of input from lawmakers, and a missing finalized CBO score certainly provided opportunities for Democrats to misrepresent the process and purpose of the AHCA. 

The battle for the perceived moral high ground in health care may be a losing one for Republicans, because no matter the legislation, the outrage from the left will likely be the same. It’s tempting for conservative lawmakers to put their heads down and proceed with blinders on, but Republicans need to get better at making their case to the American people. Conservatives can acknowledge that the ACA helped some people while still advocating a free-market-oriented system that lowers costs and improves access for those purchasing insurance. Republicans also should have better used the time between when the original AHCA was introduced and when the amended bill was passed to reiterate why the repeal and replacement of the ACA is necessary and will help American families.

Unfortunately, the misinformation about the AHCA is not a standalone concern, but a symptom of a larger cultural issue. Partisan rhetoric has always been part of the political landscape, but it is paradoxical that in this age of unlimited information — where all legislation is readily available online, along with a surplus of analysis — it is becoming more and more an instinct for people to reflexively click on and retweet claims, such as the preexisting-condition lie, that fit their preferred narrative.

At a time when the term “fake news” has become a prevalent addition to our country’s lexicon, it becomes more important than ever for government leaders to be truthful and straightforward when advocating or opposing policy. One hopes the AHCA is debated in a more substantive fashion in the Senate. Outrageous statements get more attention, but clickbait does not create sound policy and furthers the distrust in our political system.

— Juliana Darrow is a Public Interest Fellow in Washington, D.C. She is also a fellow in health-care reform at the Colorado-based Millennial Policy Center.

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