Health Insurance: Chapter 2 – Preexisting Conditions

Morgan Griffith

There are many falsehoods being spread about the American Health Care Act (AHCA).

You’ve probably heard Democrats and talking heads on the news warning that those with any preexisting conditions will no longer be able to get health insurance.

As Speaker Ryan put it, “Let’s remember what is happening right now. Obamacare is collapsing. Obamacare isn’t working. What good is Obamacare for anybody, let alone for a person with preexisting conditions if you don’t have a health insurance plan that you can even get. So this is a rescue mission to make sure that we can achieve the goals we all want, which is getting the cost of coverage down and making sure that everyone has access to affordable health care, especially and including people with preexisting conditions.”

Furthermore, the AHCA prohibits denying coverage on the basis of a preexisting condition.

Democrats on the floor last week kept saying tens of thousands would lose their coverage because of preexisting conditions.

That’s just not true.  It’s false.

Their theory is derived from the idea that if a state, in the future, requests a waiver (see below) from the Department of Health and Human Services, nobody in that state with a preexisting condition will get insurance.

Let me walk you through how it works and why the Democrats are just plain wrong.  It’s not a quick sound bite.

The waiver provisions, as included in the MacArthur amendment, would affect 7 percent of Americans who currently get health insurance from the individual market. Also, it would hopefully encourage some of the 8 percent who have currently chosen to be uninsured, to come back into the insurance market. It’s important to address health insurance needs of all Americans, but these percentages illustrate the scope of this scenario.

Out of those 7 percent, the waiver changes would only affect an individual who lives in a state that receives a waiver AND has allowed their health insurance to lapse more than 63 days.

The bill stipulates that if you have had no coverage for 64 days and then purchase health insurance, in a waiver state, with a preexisting condition, you can be charged more.  Being on Medicaid counts as being insured.

Further, if you read the bill, one or more of the following criteria must be met for the Department of Health and Human Services to accept the states’ application for a waiver.

(i) Reducing average premiums for health insurance coverage in the State.

(ii) Increasing enrollment in health insurance coverage in the State.

(iii) Stabilizing the market for health insurance coverage in the State.

(iv) Stabilizing premiums for individuals with preexisting conditions.

(v) Increasing the choice of health plans in the State.

(Note, particularly iv)

Keep in mind, even with the waivers, a person can buy insurance.  The question is, would their rates go up exorbitantly?

So for the Democrats’ dramatic claims to be true, we have to assume

  1. You are uninsured for more than 63 days
  2. You wish to enter the individual health insurance market
  3. Your state asks for a waiver
  4. Your state gets the waiver
  5. Your state crafts a plan that meets the criteria above and still leaves people out
  6. We did nothing to stop the rates from rising exorbitantly

But wait… we did something to help those with preexisting conditions who are also currently uninsured.  Because there was a concern that some people could fall into that category, the Upton-Long amendment was adopted.  That amendment provides $8 billion in funding to help pay down the cost of insurance for a person with a preexisting condition, in a state with an accepted waiver, and placed into a health care risk sharing plan.  So the cost charged to a person with a preexisting condition cannot be exorbitant.

But wait… there is even more.

The increased premiums, whether paid by the government, individual, or a combination of the two, only applies for one year under the AHCA.

If you have questions, concerns, or comments, feel free to contact my office.  You can call my Abingdon office at 276-525-1405 or my Christiansburg office at 540-381-5671. To reach my office via email, please visit my website at


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