Pregnancy, sexual assault and domestic violence could be considered “pre-existing conditions” that make it hard to keep insurance coverage under the Republican health care bill, according to a number of news articles and social media posts.
The bill doesn’t specifically refer to any of these things, and headlines suggesting that it does are misleading.
But the bill does allow insurers, in limited circumstances, to charge more for a health condition that existed before the patient’s coverage starts if that person has had a lapse in insurance. Because of that, there might be the potential in some states for a pregnant woman to be charged more for coverage.
THE CLAIM: Twitter is overflowing with lists of pre-existing conditions, patient testimonials and posts with the #iamapreexistingcondition hashtag. People living with a host of medical conditions are worried about the future of their coverage if the Republican plan becomes law. Concern has focused in particular on women’s health issues, and especially pregnancy. And claims that rape victims are singled out has stirred outrage.
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THE FACTS: One of the bigger changes to health care under the Republican plan is that it would allow insurers to consider the health risk of customers applying for new coverage if they had a recent gap in coverage. This is possible only if states apply for a federal waiver to allow it. The Affordable Care Act, which remains in place, does not permit this.
Carrying a baby also carries some risk, so insurance companies see pregnant women as risker — and more expensive — customers when they apply for coverage. The same goes for a person who was injured or sickened with a chronic illness. They consider medical conditions, not how they got injured or sick. For example, if someone sees a therapist because they have been raped, the condition that the therapist treats might be considered pre-existing but the rape would not.
Insurers have generally considered conditions treated within three months of the start of coverage to be pre-existing, health care industry consultant Robert Laszewski said.
Before the Affordable Care Act, pregnancy was considered a pre-existing condition, and insurers frequently denied coverage because of it.
They can no longer do that. But, under the Republican bill, insurers may be able to charge higher prices for a limited time due to a person’s recent medical history.