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Amy Sherman
By Amy Sherman May 24, 2017

Conservative group's ad misleads about pre-existing conditions in GOP health care bill

A political group backed by House Speaker Paul Ryan has come to the aid of fellow Republicans who voted for their party’s Affordable Health Care Act.

The American Action Network has launched two weeks of ads in 21 House districts that could face competitive races in 2018 because members voted for the bill May 4, including U.S. Rep. Carlos Curbelo of Miami and U.S. Rep. Brian Mast of the Treasure Coast.

The politically conservative group has spent $5.6 million on TV, digital and radio advertising campaigns since the House passed the legislation.

The ads, which will also run on MSNBC’s Morning Joe, are narrated by a mom who says her family lost their insurance and doctor because of the Affordable Care Act.

"But now, we have hope," she says. "House Republicans are keeping their word and fixing our broken health care system: more competition and choices resulting in lower costs and better coverage. Families get tax credits to make insurance cheaper, and people with pre-existing conditions are protected. Thank Congressman Carlos Curbelo for fighting for the better health care we deserve."

While AHCA has some language that is intended to protect those with pre-existing conditions, health care experts have previously told us that the legislation would allow insurance companies to charge more for people with pre-existing conditions.

We contacted the American Action Network’s spokeswoman but did not get a reply.

GOP bill would allow insurers to charge more for pre-existing conditions

The Affordable Care Act adopted in 2010 prohibits insurance companies from denying coverage — or charging higher premiums — because a person has a pre-existing medical condition.

The American Health Care Act, as passed by the House, does not approach pre-existing conditions the same way.

The literal language of an amendment appears to protect those with pre-existing conditions. It states that "nothing in this Act shall be construed as permitting insurers to limit access to health coverage for individuals with pre-existing conditions."

Here’s the issue: That language says insurers have to provide access for those with pre-existing conditions.

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It says nothing about the costs for those patients.

The legislation permits insurers to set premiums based on the "health status" of an individual by looking at their current and past health status and making a guess as to how they will use medical care in the future.

That means the costs would rise for consumers who are sicker, said Timothy Jost, Washington and Lee University School of Law emeritus professor.

"Health status underwriting is literally charging a higher (possibly much, unaffordably, higher) premium to people with pre-existing conditions," Jost said. "Under the MacArthur amendment, they could not be refused coverage, but insurers could impose high enough premiums that coverage would be unaffordable."

The exact amount might differ regionally, as some states might not allow the higher rates.

The legislation would allow states to obtain waivers to some requirements of the Affordable Care Act, including the "essential health benefits." The waiver would allow states to set up a high-risk pool or participate in a new federal invisible risk-sharing program to help states reimburse insurers for covering high-risk consumers.  

Republicans argue that the high-risk pools will protect those consumers with pre-existing conditions.  (Curbelo’s spokeswoman sent us a copy of the Republican talking points that make that argument.) To sweeten the legislation for Republicans on the fence before the vote, the GOP added in more money for those risk pools.

In states with a waiver, individuals who maintain continuous coverage could not be rated based on health status. However, many low-income people aren’t able to stay covered without breaks, and questions remain about the effectiveness of the high-risk pools. Many analysts believe the law would still leave those people more vulnerable to cost increases that could make their plans unaffordable.

Our ruling

An ad by the American Action Network says that under the American Health Care Act "people with pre-existing conditions are protected."

The only kernel of truth here is that the amendment has language that states insurers can’t limit access to coverage for individuals with pre-existing conditions. However, the ad omits that the House GOP health plan would weaken protections for these patients.

The legislation would allow states to give insurers the power to charge people significantly more if they had a pre-existing condition. While Republicans point to the fact that those patients could get help through high-risk pools, experts question their effectiveness.

Current law does not allow states to charge people with pre-existing conditions significantly more.

We rate this claim Mostly False.

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Under the American Health Care Act "people with pre-existing conditions are protected."
Tuesday, May 23, 2017

Our Sources

American Action Network, American Action Network Kicks Off $2 Million Nationwide TV Ad Campaign on AHCA, May 23, 2017

U.S. Health and Human Services, "Pre-Existing Conditions," Accessed May 1, 2017

U.S. Rep. Tom MacArthur, Press release, April 26, 2017

American Medical Association, "AMA Urges Congress to Oppose Amended Health Care Reform Bill," April 27, 2017

AARP, "State High-Risk Pools Failed Consumers in the Past — and Would Again," April 27, 2017

U.S. House of Representatives, Amendment to HR 1628, April 26, 2017

U.S. House of Representatives Energy and Commerce Committee, The American Health Care Act, 2017

Congressional Budget Office, American Health Care Act Cost Estimate, March 13, 2017

Kaiser Family Foundation, Compare Proposals to Replace The Affordable Care Act, accessed April 27, 2017

Health Affairs Blog, "The MacArthur Amendment Language, Race In The Federal Exchange, And Risk Adjustment Coefficients," April 25, 2017

Miami Herald’s Naked Politics blog, "Here's ad from Ryan-backed group 'thanking' Curbelo for healthcare vote," May 23, 2017

Miami Herald’s Naked Politics blog, "Curbelo, Diaz-Balart vote for Obamacare replacement," May 4, 2017

PolitiFact Florida, "Does the GOP's new health care bill still cover pre-existing conditions, as Trump claims?" May 1, 2017

PolitiFact North Carolina, "Does new version of the AHCA protect coverage for pre-existing conditions?" May 4, 2017

PolitiFact Wisconsin, "Sexual assault, domestic violence themselves are not pre-existing conditions under GOP health bill," May 9, 2017

The Washington Post’s The Fact Checker, "Fact-checking a rosy portrait of the American Health Care Act," May 24, 2017

Interview, Joanna Rodriguez, U.S. Rep. Carlos Curbelo’s spokeswoman, May 24, 2017

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Conservative group's ad misleads about pre-existing conditions in GOP health care bill

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