The Art of the Pre-Existing Condition

President Trump feels like a cough that doesn’t stop, a kind of pre-existing condition since election day that we’re stuck with.

Speaking of pre-existing conditions, remember when  Trump said that he would like to keep some of the “good parts” of Obamacare, as Business Insider reported last year. It recounted Trump’s interview with 60 Minutes, in which he said the Affordable Care Act’s “protection for people under 65 years of age with chronic medical conditions was one of its ‘strongest assets.'”

The Business Insider story said at least 52 million Americans under the age of 65 have pre-existing medical conditions, citing a Kaiser Family Foundation study. Without the Affordable Care Act, these people would have been denied insurance.

Under Trump and the GOP’s  proposed changes in their struggle to get conservatives on board for their American Health Care Act, they contradict Trump’s previous promises to preserve a  requirement that insurers cover for pre-existing conditions. Trump also promised to cover adult children, writes Health Affairs blogger, contributing editor and healthcare expert Timothy Jost. Jost is an emeritus professor at the Washington and Lee University School of Law.

The “thorough” repeal of the Affordable Care Act “would have far-ranging consequences for our health care system that can scarcely be described, much less understood,” writes Jost.

Indeed, many Americans who supported the ACA were holding their breath in hopes of keeping some of the more popular aspects of the law as Republicans continued their assault on the legislation.

As Trump and House Speaker Paul Ryan negotiated with conservatives to try to get as many votes as possible, the pre-existing ban seems to have fallen by the wayside.

“The pre-existing condition ban could be carved out of the repeal, but without the guaranteed availability requirement and health status underwriting prohibition, a pre-existing condition exclusion ban is meaningless – insurers would simply refuse to sell coverage to an applicant with a pre-existing condition,” Jost writes. “Insurers would simply refuse to sell coverage to an applicant with a preexisting condition.”

Other aspects of the proposed bill that conservatives want to delete include a requirement that provides people access to “pediatricians, obstetricians, and gynecologists, and emergency care,” among other issues.

As Jost notes, the conservatives want to target provisions of the Affordable Care Act that requires all health insurers “in the individual and small group market cover a set of ten “essential health benefits.”

Jost says that one of the biggest criticisms of the EHB is that costs of coverage have escalated.

Yet “elimination of the EHB requirement could certainly reduce coverage for certain benefits,” Jost writes.

There are big – humane – issues that should not be ignored, and sometimes these “cost changes” are penny-wise, pound-foolish.

Removing maternity coverage from insurance coverage, for example, might lower premiums by $8 to $14 per month, but would dramatically raise the cost of coverage for women in child-bearing age, and possibly make maternity care essentially an out-of-pocket expense, costing potentially $30,000 to $50,000,” Jost writes.

“Removing coverage for substance abuse disorder treatment benefits during an opioid epidemic is a questionable decision,” he adds.

So Trump is now being a tough guy, agreeing to withdraw important elements of healthcare protection to see his proposed legislation through, fast, fast, fast.

The man who wrote Art of the Deal is giving us all a headache.





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