ahca

What pre-existing conditions might not the AHCA protect?

DENVER – Perhaps the biggest question most people have after the House on Thursday passed its version of the American Health Care Act is if they have a pre-existing condition, and if it will be covered under the new health care plan, should it pass.

Though the MacArthur amendment to the AHCA explicitly says that “nothing in [the AHCA] shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with pre-existing conditions,” most medical organizations and opponents to the bill say that’s really not the case.

Instead, they say that pre-existing condition coverage will be limited by the House’s version of the bill, which would allow insurance companies to sell plans with higher deductibles and once again open up high-risk pools to cover people with pre-existing conditions, which the bill’s opponents say could lead to those people to being priced out of coverage.

Though there is no national standard for pre-existing conditions, as they are usually set by insurance companies, the number is vast. Some in Washington have said the AHCA will leave it up to the states to determine which pre-existing conditions might be covered.

The U.S. Department of Health and Human Services found in a January report that at least 61 million non-elderly Americans (23 percent of the population) have a pre-existing condition based on the narrow definition of them using state standards for high-risk pools before the Affordable Care Act was implemented.

But when HHS expanded that to a broader definition used by insurers before the ACA, that number ballooned to as many as 133 million non-elderly Americans – just over half the nation’s population under age 65, the age at which Medicare kicks in.

The report also found that about one-quarter of Americans with pre-existing conditions went without insurance for at least a month in 2014, and about one-third went without insurance for at least a month in 2013 and 2014. Lapses in coverage lead to penalties for Medicaid recipients and those trying to get pre-existing conditions covered under the AHCA as it currently stands.

“Any of these 133 million Americans could have been denied coverage, or offered coverage only at an exorbitant price, had they needed individual market health insurance before 2014 [when the ACA was implemented],” HHS wrote in its analysis.

It found that as states wound down high-risk pools and insurance companies prepared for the implementation of the ACA between 2010 and 2014, 3.6 million people with pre-existing conditions gained insurance. The uninsured rate for non-elderly Americans fell an additional 22 percent from 2014 through the first half of 2016.

So exactly what is a pre-existing condition?

The narrow definition, called the “objective definition,” included only conditions that a person received medical advice, a diagnosis, care or treatment for before they enrolled in a plan. That’s what Colorado used, according to analysis by the Kaiser Family Foundation.

Insurers were able to look back 12 months for pre-existing conditions and were able to exclude coverage for people for 12 months as well under the rules at the time. Some insurance companies would waive the exclusion period if a person hadn’t had a lapse in coverage or had the pre-existing condition covered before the lapse.

But some various insurance companies that operated in Colorado before the AHCA had more exclusions for people with pre-existing conditions on individual plans.

Per the Kaiser Family Foundation, this partial list of pre-existing conditions could be declined under the expanded definitions and were not covered before the ACA (there could be more):

  • AIDS/HIV
  • Alcohol and drug abuse within a certain time period
  • Alzheimer’s/dementia
  • Arthritis, fibromyalgia, inflammatory joint diseases
  • Cancer within a certain time period
  • Cerebral palsy
  • Congestive heart failure
  • Coronary artery/heart disease, bypass surgery
  • Crohn’s disease/ulcerative colitis
  • Chronic obstructive pulmonary disease/emphysema
  • Diabetes mellitus
  • Epilepsy
  • Hemophilia
  • Hepatitis
  • Kidney disease/renal failure
  • Lupus
  • Mental disorders, including bipolar disorder and eating disorders
  • Multiple sclerosis
  • Muscular dystrophy
  • Obesity
  • Organ transplant
  • Paraplegia
  • Paralysis
  • Parkinson’s disease
  • Pending surgery or hospitalization
  • Pregnancy (current or expectant)
  • Pneumocystic pneumonia
  • Sleep apnea
  • Stroke
  • Transsexualism

In the January report, HHS found that people with hypertension, high cholesterol, behavioral health disorders, osteoarthritis and asthma or chronic lung disease pre-existing conditions were among those with the highest uninsured rates in the country in 2010. The percentage of those uninsured fell by 22 percent by 2014 with the ACA’s implementation.

For more estimates on how pre-existing condition coverage and Medicaid coverage in Colorado may be affected, click the links in this sentence.

The House narrowly voted to pass the AHCA on to the Senate on Thursday. But it is expected to draft its own version of the bill, which Sen. Cory Gardner, R-Colo., is part of the team working on it. Senate Majority Leader Mitch McConnell said the Senate would wait for the Congressional Budget Office to score the revised bill before it votes again.


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US House passes American Health Care Act onto Senate, 217-213; see how Colorado reps voted

WASHINGTON – The U.S. House of Representatives voted Thursday to pass the American Health Care Act, the bill concocted by House Republicans and President Donald Trump to repeal and replace the Affordable Care Act passed under President Barack Obama.

The bill passed narrowly, 217-213, after extensive debate Thursday morning over how the recently-revived and revised bill would affect people with pre-existing conditions. Continue reading

Rep. Mike Coffman says he’s voting ‘no’ on the revived American Health Care Act

DENVER – U.S. Rep. Mike Coffman will vote against passing the American Health Care Act on to the Senate when the House of Representatives votes on the revived bill aimed at replacing Obamacare on Thursday.

“At this time, I cannot support the AHCA with the MacArthur amendment because I’m concerned that a small percentage of those with preexisting conditions may still not be protected,” Coffman said in a statement. Continue reading

Despite concerns over pre-existing conditions, Rep. Mike Coffman leaning yes on AHCA as vote looms

DENVER – U.S. Rep. Mike Coffman is leaning toward voting for a revived Republican plan to replace Obamacare, but says he wants to see more protection for pre-existing conditions or he’ll vote against sending the bill to the Senate.

President Donald Trump and several other House Republicans have again been trying to shore up votes this week in their ongoing effort to replace the Affordable Care Act.

Wednesday morning, those efforts grew further legs when Republican House members Fred Upton and Billy Long said they had flipped from “no” to “yes” on their plans to vote for the bill after the president accepted an amendment to the bill from Upton the Michigan Republican says will allay concerns over pre-existing condition coverage.

The bill would add $8 billion over five years to fund high-risk pools, according to multiple news outlets who had seen the amendment, which would be added to $130 billion already written into the bill.

The addition of the extra money still may be short of the money needed, according to some Republicans, who say high-risk pools would actually need between $150 and $200 billion.

Moderate and ultra-conservative Republicans, as well as Democrats, have voiced concern over the reinstatement of high-risk pools for pre-existing condition coverage under the AHCA – something Obamacare eliminated.

Last week, Coffman and his team said that the AHCA and MacArthur amendment that was added in recent weeks contained coverage for all pre-existing conditions, something House Speaker Paul Ryan reiterated, as did the president himself.

But some of the writers of Obamacare, as well as some in the health care and retirement industries, have said that even with the MacArthur amendment, people with pre-existing conditions could face not being able to afford coverage because companies and states would make it too expensive.

And though multiple requests for clarification on whether Coffman’s stance was made after the Upton amendment was introduced or before, it appears Coffman is close to supporting the measure as he said he would in March, despite ongoing pledges to protect Coloradans with pre-existing conditions.

“The current bill has a lot of strong elements – giving the states more flexibility is sound public policy…But we need to tighten some protections for those with preexisting conditions,” Coffman said in a back-and-forth statement Wednesday.

While saying there needed to be better protections for people with pre-existing conditions, he said that critics of the AHCA were being “totally disingenuous” about the reality of the bill’s language on them.

“I worry that, under the current language, a small percentage of those with preexisting conditions may not be adequately protected,” he said.

But the biggest sign that he was leaning toward a “yes” vote came with the final on-the-fence portion of Coffman’s statement:

“If House Leadership will work to tighten protections for those with preexisting conditions, I’m a yes on sending this bill to the Senate for further consideration. If not, I’m a no, and we’ll go back to the drawing board.”

Ken Buck, a Colorado Republican who is a member of the conservative Freedom Caucus, will support the bill, according to several whip counts, and other Freedom Caucus members who had been on the fence were moving toward supporting the bill Wednesday, according to reports.

Trump praised Buck for his support of the measure in late March.

Scott Tipton is “leaning yes,” according to a whip count from HuffPost’s Matt Fuller. He has also promised to protect people with pre-existing conditions under the AHCA.

But AARP, the Kaiser Family Foundation and several other national and state organizations have said the AHCA is bad for Americans, particularly those with pre-existing conditions. AARP called the Upton amendment to add $8 billion over five years a “giveaway to insurance companies” and said it “won’t help the majority of those with preexisting conditions.”

And the American Cancer Society, American Heart Association, American Diabetes Association and American Lung Association, among others, all came out Wednesday in opposition to the AHCA as it stands — even with the MacArthur and Upton amendments.

“This bill, including the MacArthur and Upton Amendments, would undermine that vital safeguard [protecting against higher charges for pre-existing conditions],” their combined statement said. “The various patches offered by lawmakers — including high-risk pools and financial assistance with premiums — do not in any way offer the same level of protection provided in current law.”

BREAKING: New statement from American Cancer Society, Heart Assn, Diabetes Assn, Lung Assn., etc. opposing MacArthur & Upton amendment. pic.twitter.com/20xkEaKxdu

— Jesse Ferguson (@JesseFFerguson) May 3, 2017
The American Medical Association on Wednesday also said the changes to the AHCA do not adequately cover people with pre-existing conditions.

“None of the legislative tweaks under consideration changes the serious harm to patients and the health care delivery system if AHCA passes,” said AMA President Andrew W. Gurman, M.D. “High-risk pools are not a new idea. Prior to the enactment of the Affordable Care Act, 35 states operated high-risk pools, and they were not a panacea for Americans with pre-existing medical conditions. The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage – if they are able to obtain coverage at all.”

Colorado’s past with high-risk pools

Colorado has experience with high-risk pools, as it had them from 1990 until 2014, when they were eliminated with the implementation of Connect for Health Colorado, the state health exchange operating under Obamacare.

Colorado was one of 35 states that offered high-risk pools, which are plans that cover people who can’t typically get health insurance – many of them because of their pre-existing conditions.

The state covers much of the funds for the pools through various fees, but insurance companies can raise prices so that state coverage won’t cover care beyond premiums. Federal subsidies also contributed to Colorado’s high-risk pools when they were in place under CoverColorado, the state high-risk pool program.

In 2009, the Colorado Legislative Council found there were around 9,200 people in the state covered through CoverColorado. The plans carried premium caps at 150 percent of standard rates and deductibles of between $1,000 and $5,000, with lifetime deductibles capped at $1 million.

But it found that high health care costs meant that premiums weren’t covering the full cost, despite close to 30 percent of low-income recipients receiving discounts on their premiums.

By the end of 2011, however, the number of Coloradans covered under high-risk pools was close to 14,000 – the sixth-most populous high-risk pool in the country. That accounted for 3.5 percent of the non-group market enrollment that year in the state.

Though many states’ high-risk pools excluded coverage for pre-existing condition for people otherwise eligible for coverage for between 6 and 12 months, Colorado was one of two states that only excluded coverage for the first three months.

And before the ACA effectively eliminated high-risk pools by forcing insurers to exempt pre-existing conditions when considering coverage, the list of pre-existing conditions that would not be covered in Colorado was extensive.

This was Anthem’s medical condition rejection list pre-Obamacare in Colorado:

The Congressional Budget Office has yet to score the revised AHCA, but said in its original analysis that 24 million fewer people would be insured in the next decade than would have been under Obamacare. It also said that the AHCA would have devastating effects on Medicaid across the country.

Colorado’s Medicaid program could suffer losses topping $10 billion, according to analysis.

The Colorado Consumer Health Initiative blasted the revised AHCA Wednesday.

“Coloradans have experience with high-risk pools from before the Affordable Care Act, and it doesn’t work,” said the organization’s spokesman, Adam Fox, saying Coffman has “flipflopped” on his stance to protect Coloradans with pre-existing conditions.

“An additional $8 billion doesn’t magically make high-risk pools work, and Coffman, as a fiscal conservative, should know better than to throw money at a failed idea,” Fox continued. “This isn’t what people in America or Colorado want. It is time for the GOP to drop this crazed fixation on repeal — and move on.”

Late Wednesday, Ryan said the full House would vote on the AHCA on Thursday.

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