While fighting for their political lives ahead of the midterms, President Donald Trump and members of his party have repeatedly said they would never take away insurance protections for people with pre-existing conditions like diabetes, cancer, and mental illness.
Arizona Republican Senate candidate Martha McSally said she’s “leading the fight” to “force insurance companies to cover pre-existing conditions.”
Republican candidates like Florida Gov. Rick Scott, who is running for Senate, and Wisconsin Gov. Scott Walker, who is running to keep his job, have highlighted their own experiences with pre-existing conditions in political ads.
“Republicans will totally protect people with pre-existing conditions!” Trump tweeted.
By voicing their support of protecting complete coverage for people with pre-existing conditions, however, Republicans are staring down their own records on health care. Last year, the GOP repeatedly — and unsuccessfully — tried to axe the Affordable Care Act, which guarantees those protections. Now, they’ve even filed a lawsuit that would upend the legislation and tried to pass their own bills and proposals that could make coverage more expensive for some people with pre-existing conditions.
Here are some of the ways in which Republicans have attempted to do away with the existing protections:
Lawsuit to repeal the Affordable Care Act
There’s a complicated, GOP-backed lawsuit lingering in a Texas court that could unravel the Affordable Care Act and its provision that guarantees equal insurance coverage to people with pre-existing conditions. In February, 20 Republican attorneys general, led by Texas, filed the lawsuit to overturn Obamacare in its entirety. Lawyers for the Trump administration stepped in to back the litigation. In an interview with Bloomberg News, Senate Majority Leader Mitch McConnell further defended the lawsuit, even though it’s become a problem for candidates.
“There’s just a belief that people will forget what they’ve voted for and what they’re actively doing today,” said Sabrina Corlette, research professor at the Georgetown University Health Policy Institute. “They’re literally in court today, as we speak, arguing for this stuff to be declared unconstitutional.”
Republicans have also repeatedly attempted to repeal and replace the Affordable Care Act with plans that offer less comprehensive protections for people with pre-existing conditions.
In August, 10 Senate Republicans came back with another bill called Ensuring Coverage for Patients with Pre-Existing Conditions. The bill didn’t allow insurers to flat-out exclude people with pre-existing conditions, but its language — or lack of language — did offer some loopholes for charging people more money after they’re accepted. For example, insurers could be allowed to charge people more based on age, neighborhood, or occupation, which often factor into pre-existing conditions.
Previous Republican plans have also had loopholes to allow varying premium rates for customers or that would allow states to offer cheaper, skimpier plans that are more attractive to healthy people, which could drive up costs for sick people who need the better coverage.
“In their legislation, they include this quotable, broad language,” said Mark Fendrick, director of the bipartisan Center for Value-Based Insurance Design at the University of Michigan. “But in every single proposal, it’s all about the possibility for loopholes that health plans could possibly take advantage of.”
Even if Republicans can’t fully repeal and replace the Affordable Care Act, they’ve introduced other proposals that undermine its intention of creating an equal insurance marketplace.
In August, for example, the Trump administration unveiled a rule to allow greater access to cheaper, short-term health insurance plans. These plans are attractive to healthy people, but they’re allowed to shut out cancer survivors, people with diabetes, and pregnant women, for example. Congress also cut the individual mandate, which taxed people who didn’t have the regulated, Affordable Care Act plans in an attempt to keep them away from skimpier options like short-term health insurance.
Without that penalty, healthy people could exit the marketplace for the short-term plans and, in the long run, drive up costs for the sick people that need the more expensive, comprehensive plans.
“We saw policies that excluded chemotherapy before the ACA,” said Linda Blumberg, an institute fellow at the health policy center of the Urban Institute. “We’ll see them again with the short-term limited duration policy.”
Cover image: President Donald Trump gives thumbs up as he steps off Air Force One as he arrives Monday, Oct. 8, 2018, at Andrews Air Force Base, Md. (AP Photo/Alex Brandon)