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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.

Cases: 595436

Reported Deaths: 9466
CountyCasesDeaths
Marion822851311
Lake44626670
Allen32165543
Hamilton28684308
St. Joseph26917378
Elkhart24173343
Vanderburgh18856236
Tippecanoe17638125
Johnson14687289
Porter14513163
Hendricks14010242
Madison10715216
Vigo10540177
Clark10349135
Monroe9189108
Delaware8956134
LaPorte8867158
Howard7982140
Kosciusko791380
Warrick652994
Hancock646999
Bartholomew631096
Floyd6205107
Wayne5984159
Grant5874110
Dubois547175
Boone538867
Morgan524192
Henry497764
Marshall495384
Cass475362
Dearborn464545
Noble463157
Jackson417846
Shelby405680
Lawrence383876
Clinton367840
Gibson360058
DeKalb339163
Montgomery338152
Harrison333643
Knox329839
Miami312743
Steuben309343
Adams297435
Whitley297225
Wabash294947
Ripley294345
Putnam288047
Jasper285234
Huntington284959
White269138
Daviess263073
Jefferson253838
Decatur243482
Fayette242948
Greene237062
Posey234427
Wells231347
LaGrange225061
Clay219032
Scott218538
Randolph209845
Jennings193935
Sullivan189632
Spencer184319
Fountain180527
Washington179321
Starke172743
Jay163922
Fulton161130
Owen161137
Carroll153915
Orange152933
Rush151618
Perry149327
Vermillion145833
Franklin144433
Tipton129232
Parke12918
Pike114326
Blackford109222
Pulaski95337
Newton89821
Brown85931
Benton85310
Crawford7719
Martin70713
Warren6637
Switzerland6235
Union6146
Ohio4727
Unassigned0374

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 836049

Reported Deaths: 10323
CountyCasesDeaths
Franklin98533705
Cuyahoga831801065
Hamilton61931441
Montgomery42028399
Summit33849736
Lucas30524605
Butler30003228
Stark25093419
Warren19083140
Lorain18418212
Mahoning16931337
Lake15592136
Clermont15335105
Delaware1403077
Licking12819132
Trumbull12515307
Fairfield1232480
Greene11729135
Medina11286165
Clark10672264
Wood10081156
Allen9639126
Portage9006107
Miami895273
Richland8910116
Marion7377113
Tuscarawas7177174
Columbiana7164124
Pickaway710350
Wayne6855165
Muskingum678241
Erie5976118
Hancock542990
Ross535287
Scioto527063
Geauga491755
Darke459489
Ashtabula443172
Lawrence439353
Union437028
Sandusky427462
Mercer427387
Seneca417357
Auglaize416259
Huron416138
Shelby413521
Jefferson409066
Belmont403740
Washington375940
Putnam367872
Athens36759
Madison343429
Knox340122
Ashland336838
Fulton328543
Defiance322578
Crawford316371
Preble313836
Brown298819
Logan296529
Ottawa283934
Clinton281243
Williams272866
Highland266018
Jackson259043
Guernsey245325
Champaign244427
Fayette229729
Morrow22574
Perry223318
Holmes220362
Henry213547
Hardin206433
Coshocton199620
Van Wert198744
Wyandot192549
Gallia192126
Adams167415
Pike167417
Hocking165523
Carroll151316
Paulding141121
Noble118740
Meigs105021
Monroe97229
Harrison8598
Morgan79728
Vinton67613
Unassigned00
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