Center for American Progress

RELEASE: Senate Bill Would Weaken Protections for Pre-Existing Conditions
Press Release

RELEASE: Senate Bill Would Weaken Protections for Pre-Existing Conditions

Washington, D.C. — While Senate Majority Leader Mitch McConnell (R-KY) continues to hold closed-door discussions around the Senate Republican version of the deeply unpopular American Health Care Act (AHCA), a new column from the Center for American Progress uses reported details of the plan to outline how the bill would critically weaken protections for individuals with pre-existing conditions. Even if the bill does not include waivers for community rating, as the House bill did, it would weaken protections by letting states waive essential health benefit (EHB) standards. The inclusion of an age tax and rollback of the Medicaid expansion would compound the negative impact.

Like the House-passed bill, the Senate version reportedly allows individual states to waive the Affordable Care Act requirement that insurance companies to cover services such as maternity care, mental health and substance abuse care, hospitalization, and prescription drugs. People with pre-existing conditions in EHB waiver states would face significantly higher costs and find it much harder to find insurance plans that covered treatment for even relatively common conditions such as mental health problems or diabetes. Furthermore, this would lead to a race to the bottom as insurers reduced their benefits in an effort to avoid attracting sick enrollees who need comprehensive benefits to treat their conditions. Insurers that did continue to offer comprehensive benefits would be forced to increase their premiums significantly.

The bill would also include an age tax, which would allow insurers to charge older Americans—who are more likely to have pre-existing conditions—five times more than younger enrollees.

“Make no mistake, the new Senate bill being discussed has similar, devastating consequences to the House bill. Even if it doesn’t include community rating waivers, the waivers for essential benefits would allow insurers to screen out sick people by reducing benefits. The bill would generate a race to the bottom among insurers to provide the most bare-bones coverage to discourage sick people from signing up. This backward system would do undue harm to sick, older, and low-income Americans,” said Thomas Huelskoetter, policy analyst for the Health Policy team at CAP.

CAP estimates that:

  • About 5.3 million individual market enrollees with pre-existing conditions live in states that would waive EHBs and would see their protections eroded.
  • 4.3 million enrollees ages 55 to 64 with pre-existing conditions would be hit with an age tax; under the CBO’s projection, about 2.2 million of these people would live in EHB waiver states and would be face much higher health care costs.
  • Nationwide, about 5.4 million newly eligible Medicaid expansion enrollees have pre-existing conditions; under the CBO’s projection, about 2.7 million of these people would live in waiver states.

Read the column: “Senate Repeal Bill Would Still Eviscerate Coverage and Protections for People with Pre-Existing Conditions” by Thomas Huelskoetter and Emily Gee

For more information on this topic or to speak with an expert, contact Chelsea Kiene at or 202.478.5328.