What You Should Know About Pre-Existing Conditions in Trumpcare

The latest version of Trumpcare is pretty unfavorable for those with pre-existing conditions, as confirmed by the Congressional Budget Office’s recent analysis (the 'CBO score'). But are you aware if you have a pre-existing condition? Does something like sexual assault qualify? Let's explore this further.

This is important because the new healthcare proposal could allow insurers to increase your rates based on your health status. Before the ACA, it was almost impossible to buy insurance if you had any health issues. Under Trumpcare, it wouldn't be quite as extreme: you only need to worry about pre-existing conditions if you had a two-month gap without insurance and reside in a state with a waiver allowing non-compliance with the law.

Moreover, insurers can't outright refuse coverage due to a pre-existing condition. However, they can set their premiums so high that you can't afford them. The Center for American Progress estimates that women who have given birth would face an additional $17,060 in annual premiums compared to those who haven't. For cancer survivors, premiums could rise above $140,000 per year. Yes, your premiums.

You might think, 'I don't plan on having a coverage gap.' But keep in mind that, for many, insurance could become more expensive than it is now. If you lose your job and can't cover COBRA payments, you might be the one facing a coverage gap. (Before the ACA, many individuals with chronic conditions were often stuck in poor jobs because they couldn't afford to lose their health insurance.)

The latest CBO score reveals that one-sixth of the U.S. population lives in areas where the health insurance market could become 'unstable' if the new bill is passed. In states that request waivers, this scenario is highly likely to unfold:

Community-rated premiums will rise over time, and individuals with poorer health (including those with pre-existing or newly acquired conditions)

may ultimately struggle to buy comprehensive individual health insurance at premiums similar to what’s available under current law, if they can purchase it at all—even with the extra funding provided by H.R. 1628 to help lower premiums.

So technically, insurers must offer you coverage even if you have a pre-existing condition—but they might charge such high premiums that it’s effectively unaffordable.

Trumpcare Does Not Define Pre-Existing Conditions

There's a sort of misconception that the healthcare bill defines sexual assault, domestic violence, and prior c-sections as pre-existing conditions—yet excludes erectile dysfunction. This is actually incorrect: the bill does not provide a list of pre-existing conditions.

The ACA didn’t specifically define pre-existing conditions, because it effectively eliminated the concept. Insurers were required to set their rates based on factors like age and smoking habits—referred to as 'community rating'—and could no longer charge different prices based on your health status.

The new healthcare bill removes this provision. If a state applies for a waiver, insurers in that state would be allowed to use health status to determine premiums once again. For younger, healthier individuals, insurance will be affordable. But if you develop a health issue, things could take a turn for the worse. A gap in coverage could mean finding yourself facing skyrocketing premiums when you need to shop for insurance again.

A Lot of Us Have Pre-Existing Conditions

It’s not the law that decides what qualifies as a pre-existing condition; it’s the insurance companies themselves. If the CEO of Aetna decides to raise premiums for people with minor issues like hangnails, baldness, or a history of broken ankles, they can. More realistically, insurers typically increase costs for people who are more likely to require expensive medical care in the future.

According to a report by the Kaiser Family Foundation, about a quarter of American adults under 65 had pre-existing conditions that would have made them 'declinable'—meaning they could have been denied coverage—before the ACA. In 2015, 6.5 million people had pre-existing conditions and a gap in their insurance.

The Kaiser Family Foundation also provides data on what pre-existing conditions were considered. These conditions varied by insurer, but some of the most commonly listed as 'declinable' include:

• AIDS/HIV

• Alcohol abuse/Drug abuse with recent treatment

• Alzheimer’s/dementia

• Rheumatoid arthritis, fibromyalgia, other inflammatory joint diseases

• Cancer within a specific timeframe (e.g. 10 years, excluding basal skin cancer)

• Cerebral palsy

• Congestive heart failure

• Coronary artery disease/heart disease, bypass surgery

• Crohn’s disease/ulcerative colitis

• Chronic obstructive pulmonary disease (COPD)/emphysema

• Diabetes mellitus

• Epilepsy

• Hemophilia

• Hepatitis (Hep C)

• Kidney disease, renal failure

• Lupus

• Mental disorders (severe, e.g., bipolar disorder, eating disorders)

• Multiple sclerosis

• Muscular dystrophy

• Severe obesity

• Organ transplants

• Paraplegia

• Paralysis

• Parkinson’s disease

• Pending surgery or hospitalization

• Pneumocystic pneumonia

• Pregnancy or expectant parent

• Sleep apnea

• Stroke

• 'Transsexualism'

Keep in mind, these are just the most common conditions found on pre-existing condition lists. Could sexual assault be considered a pre-existing condition? It’s possible, but there's no evidence that this was widespread. Similarly, minor issues like acne or mild depression: could insurers raise your rates for these? Certainly, and some did. Will they in the future? That remains uncertain.

In other words, the healthcare bill doesn’t specify any conditions that are automatically fair game for insurers, but it also doesn’t guarantee protection for any conditions either.

Insurers used to maintain lists of medications that could disqualify you, such as those for HIV, cancer, heart disease, diabetes, and more. There were also certain jobs that could disqualify you, like being a firefighter, taxi driver, or—famously—coal miner, a job beloved by the president. These aren’t likely to be classified as pre-existing conditions now, but it’s hard to predict how policies will evolve under the new law, as they haven’t been finalized yet.

The bill has yet to become law. Although it has passed the House, the Senate is currently drafting its own version. If you have thoughts on what it should include, consider reaching out to your Senator to share your opinion.