Earlier this month, New Jersey Rep. Tom MacArthur introduced the GOP's latest attempt to repeal and replace the Affordable Care Act, commonly known as "Obamacare." Legislative language for this amendment to the American Health Care Act — the broader act dubbed "Trumpcare" in response — was finally released to the public via the House Rules Committee website this week, and it's a doozy. The lynchpin of the contentious debate on Capitol Hill to repeal the ACA comes down to pre-existing conditions — specifically, the mandate under Title I of the ACA that protects people who have them. Worse, repealing Title I of the ACA hurts kids whose health depends on that coverage.
Prior to the ACA, health insurance companies could deny coverage to anyone with a pre-existing condition — including children. For children, pre-existing conditions can include anything from asthma and type I diabetes to rare cancers and basically any other illness. According to The Chicago Tribune, just prior to the enactment of the ACA in 2010, there were an estimated 57.2 million Americans with pre-existing conditions under the age of 65 — of those, a staggering 9 percent were children. If the ACA is repealed, this key Title I provision to protect children goes with it.
On Sunday, President Trump appeared on Face The Nation saying the MacArthur Amendment has a clause that "guarantees" pre-existing condition coverage. But when looked at more closely, those protections aren't all they're cracked up to be, especially for kids.
Here's the actual language that "protects" pre-existing condition coverage, from the MacArthur Amendment. I use the term "protects" loosely here, because there's a big difference between access and affordability:
No limiting access to coverage for individuals with preexisting conditions.—Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.
So while health insurers can't necessarily deny children — or anyone — coverage based on pre-existing conditions, it doesn't mean they can't hike rates to cover those conditions. Basically, pre-existing conditions would be consolidated into high-risk pools, which Trump confirmed on Sunday. Specifically, Trump said, the amendment would "set up a pool for the pre-existing conditions so that the premiums can be allowed to fall."
While falling premiums certainly sound enticing, the fact of the matter is, if your child becomes part of a high-risk pool because of his or her pre-existing condition, your premiums are likely going to go up — way up. In a review of the MacArthur Amendment, the Center on Budget and Policy Priorities spelled out how higher premiums would effectively amount to a denial of coverage:
Exorbitant premiums and coverage exclusions are, in practice, no different than coverage denials. Rep. MacArthur has stressed that, under the amendment, insurers couldn’t deny coverage altogether to people with pre-existing conditions. But an insurer that wanted to deny someone coverage could simply offer her a plan with a premium of tens of thousands of dollars per month and without coverage for hospitalizations, prescription drugs, or various other basic health services. For a consumer, such an “offer” is no different than a denial.
Sure, Republicans claim they're keeping Trump's promises to keep access to pre-existing condition coverage, but there's nothing in the ACA repeal that maintains any sense of affordability for Americans — and it could end up hurting some of America's most vulnerable patient populations — such as children with pre-existing conditions — the hardest.