aca pre existing conditions

protections for people with preexisting medical conditions will continue to be a hot topic as the 2020 election cycle heats up. these parts of the law, as well as subsidies for low- and middle-income people and medicaid expansion, have been critical in extending health insurance to 20 million americans since the aca was enacted in 2010. covering preexisting conditions is a challenge that is unique to the private health insurance system. insurers maintained lists of health conditions that triggered the denial of an application and outright reject anyone with a preexisting condition or not otherwise in perfect health. in most states, insurers broadly excluded coverage of preexisting conditions, the definition of which varied by state but often extended even to conditions that were undiagnosed. these restrictions applied for all enrollees but often targeted health care services that people with preexisting chronic conditions would need, providing a further disincentive for these individuals not to enroll in coverage and furthering the likelihood that insurers would not have to pay high claims even if they did enroll.

based on these metrics, many current proposals discussed below give only lip service to protecting people with preexisting conditions and would leave gaps for those in need of affordable, comprehensive health insurance. while these proposals make for good messaging, each has gaps that would leave people with preexisting conditions vulnerable to higher premiums, higher out-of-pocket costs, and denied benefits relative to the aca. so, people with preexisting conditions could not be charged more (at least not based on health status), but, without explicit guaranteed issue, they may not be healthy enough to be issued a policy in the first place. instead of guaranteed issue and a ban on preexisting condition exclusions, the committee would require “continuous coverage” where those who fail to maintain a full year of prior coverage could have their preexisting conditions excluded for a period up to the next 12 months. this meant that individuals fortunate enough to afford a policy through the high-risk pool would not actually have coverage for the health care services they needed to treat their preexisting condition.

“if the aca were overturned, it would leave people who have pre-existing conditions vulnerable once again to many of the health and financial risks that existed before the aca.” with the affordable care act (aca) again at risk through the suit to strike down the law that is before the supreme court, some of its detractors are backing proposals they say would restore popular protections for people with pre-existing conditions if the law is overturned. with no requirement for insurers to cover these medications, it would fear being the only company to do so and attracting all applicants in that area who have hiv. eliminating the aca’s financial assistance would put coverage out of reach for millions of low- and moderate-income consumers, including many with pre-existing conditions.

this includes the american health care act, a repeal bill[20] the house passed in 2017, and a bill proposed by senators bill cassidy and lindsay graham (“cassidy-graham”) that would have let states opt out of most pre-existing condition protections. [5] aviva aron-dine, “trump’s health care plan would do much the same damage as his effort to repeal aca through the courts,” cbpp, july 8, 2019, /blog/trumps-health-care-plan-would-do-much-the-same-damage-as-his-effort-to-repeal-the-aca-through; and “trump administration’s repeal suit stance is in line with its health care agenda,” cbpp, updated february 21, 2020, /research/health/trump-administrations-aca-repeal-suit-stance-is-in-line-with-its-health-care-agenda. [21] aviva aron-dine, “cassidy-graham’s waiver authority would gut protections for people with pre-existing conditions,” cbpp, september 15, 2017, /blog/cassidy-grahams-waiver-authority-would-gut-protections-for-people-with-pre-existing-conditions.

health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as no insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. once pre-existing condition a health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. insurance companies can’t, .

the patient protection and affordable care act (aca) prohibits the use of pre-existing conditions—such as heart disease or a cancer diagnosis—to deny, prior to the affordable care act, in the vast majority of states, insurance companies in the individual and small group markets could deny coverage, charge the aca addressed these gaps by improving the availability, affordability, and adequacy of private health insurance. beginning in 2014, the aca, .

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