People with pre-existing conditions could face tough times ahead

President Donald Trump and his administration are taking steps to lower premiums, increase choice and foster competit...

Posted: Mar 1, 2018 2:35 PM
Updated: Mar 1, 2018 2:35 PM

President Donald Trump and his administration are taking steps to lower premiums, increase choice and foster competition in the health insurance market. All of that sounds good -- until one realizes that the changes are coming largely at the expense of millions of Americans with pre-existing conditions.

The administration has issued two proposed rules in recent months that will allow more people to sign up for alternatives to Obamacare. But the actions are expected to mainly help younger and healthier consumers, while hurting those with spottier health histories.

That's because the proposed regulations, combined with Congress' elimination of the individual mandate next year, will whittle away at Obamacare's sweeping protections for those with pre-existing conditions. This will leave those who are or who have been sick at risk of paying higher premiums, losing their comprehensive coverage or being left without an insurer on the Affordable Care Act exchanges.

"The end result is that you will have two markets," said Sabrina Corlette, research professor at Georgetown University's Health Policy Institute. "One that's for young and healthy individuals who don't need a lot of health care, and another that will provide comprehensive coverage for people with pre-existing conditions, but will be much more expensive."

Obamacare revolutionized health insurance for people with pre-existing conditions. Under the health reform law, insurers could no longer deny coverage to consumers because of their medical history or base premiums on it. Also, carriers were required to cover 10 essential health benefits, including maternity care, mental health services and prescription drugs.

These provisions were among Obamacare's most popular reforms, but they were also one of the main reasons why coverage on the individual market became so pricey. That has made these protections a target.

Shortly after Congress abandoned its attempt to repeal and replace Obamacare in late September, Trump issued an executive order that he said would give millions of Americans more access to affordable coverage. The president's directive laid the foundations for the two proposed rules.

The first one, unveiled in early January, would make it easier for small businesses to band together based on their industry or location and buy coverage through so-called association health plans.

The proposal would allow association plans to be regulated in the same way as large employer plans. That would free them from having to adhere to all of Obamacare's rules, particularly the one requiring insurers to offer comprehensive coverage. So these plans would likely have lower premiums, but also provide fewer benefits -- which could leave sicker and older workers out in the cold. Also, the offerings could be less attractive to young women if they don't cover maternity benefits.

Related: Trump officials unveil rule that could chip away at Obamacare

The proposed regulation would also allow associations to base rates on gender and age, which could leave younger men paying less but older workers and women saddled with higher rates. Currently, the Affordable Care Act bans basing premiums on gender and limits the amount that can be based on age. However, plans would not be allowed to set premiums based on workers' health status.

If the proposed rule is finalized in coming weeks, premiums for Obamacare policies would rise 3.5% to an average of $15,000 a year, largely because healthier enrollees would opt for association plans, according to a new study by Avalere Health, a consulting firm. Those buying the new small business plans would pay $5,300, on average.

"The proposed rule would lead to millions of individuals and small businesses shifting into a new form of coverage, likely reducing their premiums, but leading to higher premiums in the markets they leave behind," said Chris Sloan, senior manager at Avalere.

The administration's second proposed regulation, which was released last week, will make it easier to obtain coverage through short-term health insurance plans by allowing insurers to sell policies that last just under a year. The proposal would reverse an Obama administration decision to limit the duration of short-term health plans to no more than 90 days in order to make them less attractive.

Short-term plans are allowed to exclude those with pre-existing conditions and can base rates on an applicant's medical history. They don't have to offer comprehensive coverage and they can impose annual or lifetime limits on benefits, meaning they may only pay out a set amount -- often $1 million or less -- leaving the policyholder on the hook for the rest. Also, they don't have to cap the amount consumers have to pay in deductibles and co-pays every year.

Related: Trump administration unveils alternative to Obamacare

Consumers today can find short-term plans that cost as little as 20% of the least expensive Obamacare plan, according to the Kaiser Family Foundation. Once short-term plans are available, healthy people may turn to them instead of Obamacare policies, pushing up the rates for those who remain on the exchanges.

Congress' elimination of the individual mandate could also hurt those with pre-existing conditions, particularly those who don't qualify for federal premium subsidies, health policy experts say. Without the mandate, which requires nearly all Americans to get coverage or pay a penalty, healthy people will have less incentive to enroll. So premiums for those left on the exchanges are likely to rise.

Even more concerning, experts are waiting to see whether insurers want to remain on the exchanges in 2019 if policyholders are older and sicker. For a while last year, it looked like tens of thousands of people could have had no choice of insurer in 2018 as carriers dropped out amid all the uncertainty in Washington D.C. However, state officials were able to convince insurers to cover all the so-called bare counties before open enrollment began in November.

Indiana Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 147582

Reported Deaths: 3937
CountyConfirmedDeaths
Marion24410780
Lake12911350
St. Joseph8651154
Elkhart8281130
Allen7756221
Hamilton5872113
Vanderburgh547750
Tippecanoe346414
Monroe316238
Hendricks3116130
Johnson2947127
Porter288948
Clark280857
Delaware277174
Vigo245534
Madison224587
Cass220120
LaPorte208853
Warrick185362
Floyd170865
Kosciusko169221
Howard155366
Bartholomew137557
Dubois133423
Marshall129826
Henry120728
Boone117748
Grant116839
Wayne114923
Hancock112844
Noble110033
Jackson106412
Morgan90840
Dearborn89528
Daviess82732
Gibson8229
Clinton80116
Shelby76929
Lawrence76732
LaGrange76114
Harrison72924
Putnam69415
Knox68610
DeKalb67411
Posey6695
Steuben5798
Miami5655
Montgomery55722
Fayette55615
White55615
Jasper5264
Greene50537
Scott50313
Decatur49339
Adams4555
Clay4266
Whitley4246
Ripley4138
Sullivan40612
Wells4045
Orange38124
Starke3787
Wabash3769
Spencer3656
Huntington3645
Franklin35925
Jennings35813
Washington3452
Randolph3318
Jefferson3275
Fulton3232
Pike31512
Carroll30513
Perry28214
Jay2756
Fountain2733
Tipton26123
Parke2152
Newton20511
Vermillion2031
Owen1991
Rush1984
Martin1930
Blackford1843
Crawford1401
Pulaski1401
Brown1283
Ohio1167
Benton1060
Union1010
Switzerland840
Warren721
Unassigned0233

Ohio Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 181787

Reported Deaths: 5067
CountyConfirmedDeaths
Franklin30590635
Cuyahoga19212671
Hamilton15890338
Montgomery9883184
Lucas8058370
Butler7856122
Summit6406260
Warren393360
Stark3605178
Mahoning3567283
Marion332149
Pickaway294646
Delaware275927
Lorain262389
Fairfield254156
Licking241065
Wood240181
Clark231654
Clermont225936
Trumbull2174134
Greene210840
Columbiana207887
Allen195873
Miami191056
Lake184757
Medina175542
Portage153067
Mercer143327
Ross130533
Wayne125968
Richland125724
Tuscarawas117822
Athens11452
Erie111453
Darke108850
Madison101314
Hancock97520
Auglaize92716
Lawrence88524
Putnam86127
Shelby85014
Geauga81950
Muskingum8174
Scioto7709
Belmont76827
Union7203
Ashtabula71348
Huron6909
Sandusky69022
Seneca57614
Preble57417
Ottawa55930
Holmes53710
Fulton4726
Henry44217
Jefferson4384
Defiance43713
Clinton42013
Jackson4197
Fayette4188
Crawford4088
Logan3923
Champaign3783
Highland3714
Ashland3705
Brown3583
Knox35215
Perry35011
Washington32423
Morrow3222
Williams3124
Hardin30913
Coshocton28612
Pike2780
Wyandot27813
Gallia27413
Guernsey2688
Van Wert2153
Meigs20512
Adams1936
Hocking1899
Carroll1887
Paulding1791
Monroe14118
Noble1120
Vinton853
Harrison763
Morgan690
Unassigned00
Fort Wayne
Overcast
48° wxIcon
Hi: 48° Lo: 39°
Feels Like: 46°
Angola
Overcast
45° wxIcon
Hi: 45° Lo: 36°
Feels Like: 45°
Huntington
Overcast
46° wxIcon
Hi: 48° Lo: 39°
Feels Like: 46°
Decatur
Overcast
46° wxIcon
Hi: 48° Lo: 40°
Feels Like: 44°
Van Wert
Overcast
46° wxIcon
Hi: 48° Lo: 40°
Feels Like: 44°
Cloudy Tuesday
WFFT Radar
WFFT Temperatures
WFFT National

Community Events