Jose Luis Magana / AP
Saturday, May 6, 2017 | 2 a.m.
From the moment the Republican-controlled House of Representatives approved a plan to overhaul the health care system, an onslaught of opposition to the bill has been focused on a single, compact term: pre-existing conditions.
The Democratic Congressional Campaign Committee began running digital ads warning that the legislation would leave “no more protections” for people with a history of illness or injury. Pointing to the power that states could have to set the terms for insurers under the Republican bill, Democratic leaders announced they would make pre-existing conditions an issue in every gubernatorial and state legislative race in the country.
Groups on the left posted graphics online listing pre-existing conditions that could, in theory, threaten health care coverage, with some shared hundreds of thousands or millions of times. In one exaggerated claim circulating widely on social media Friday, a post from a group called The People for Bernie Sanders listed nearly 100 conditions, from AIDS to ulcers, and said that for anyone who suffered from them, Republicans had voted “to end your health care.”
Individuals took up the call, too: More than 100,000 people posted on Twitter using the hashtag #IAmAPreexistingCondition, with many naming their own long-term illnesses or medical conditions.
The blast of organized and grass-roots energy in opposition to the bill had all been generated by one measure, added to the legislation to assure its passage, that allowed states to seek federal waivers to ignore certain mandates in the Affordable Care Act — including the one blocking insurance companies from charging people more because of pre-existing conditions.
More than anything else in the bill, Democrats and health care advocates have used that provision as a rallying cry, warning that it could inflict punishing costs on people with ailments from asthma to cancer, as well as on pregnant women.
Gov. Dannel P. Malloy of Connecticut, chairman of the Democratic Governors Association, said the issue was so resonant because every voter has at least “an uncle or an aunt or a distant cousin who’s a diabetic or has a heart condition.” He said he was urging Democratic candidates to press their opponents to take a categorical position on the health care bill, which President Donald Trump endorsed forcefully.
“Either you agree with the president or you don’t agree with the president,” Malloy said in an interview. “If you don’t agree with the president, you need to say it.”
Opponents of the bill have depicted its potential impact in nightmarish and sometimes overstated terms, suggesting it would completely void protections for sick people. In reality, insurers would still not be able to deny people coverage altogether, and states seeking waivers would have to show they had alternative programs to aid the people most at risk. People could be charged based on their health status only if they bought coverage through the individual market and had experienced a gap in coverage.
But many of the Democrats’ dire warnings are not far off the mark: Prices could indeed prove prohibitive.
And the political potency of these attacks is undeniable. Where the Affordable Care Act draws an iron rule governing coverage for people with pre-existing conditions, the Republican plan would create an opening for state-level programs that would likely offer far thinner protections for the roughly eight percent of Americans who rely on the individual market for coverage.
A host of health advocacy groups, including the American Lung Association and the American Cancer Society, reviewed the legislation and concluded it would weaken protections for people with ongoing medical issues.
States could also seek waivers from requirements that insurers cover 10 “essential health benefits,” including maternity, mental health and prescription drugs, and that they charge their oldest customers no more than three times more than their youngest ones. Waiving the essential benefits could also potentially weaken prohibitions on insurers limiting the amount of care they cover, even in employer plans.
Ben Wikler, Washington director of MoveOn.org, said that by imperiling the protections for people with a history of illness, Republicans had turned the health care bill into “something that feels like a life-or-death struggle,” even for people who would have been unaffected by the rest of the bill.
“This whole bill was already radioactive, but pre-existing conditions make it a nuclear power plant for the resistance movement,” Wikler said.
The criticism has not come only from the left: A number of Republicans who voted against the bill specifically cited the possibility that it could make it harder for people with serious medical conditions to buy insurance. On Friday, chapters of the AARP, which also lobbied against the bill, criticized individual House members on Twitter for voting “yes on harming ppl w/preexisting conditions.”
Public polling has found those protections to be among the most popular elements of the Affordable Care Act, even in the first years after its passage when it faced tremendous blowback from voters. A poll last month by The Washington Post and ABC News found that 7 in 10 Americans believed that all 50 states should be covered by regulations preventing insurers from setting higher rates for people with pre-existing conditions.
Even at the height of Republican opposition to the Affordable Care Act, leading members of the party, including Mitt Romney, the 2012 presidential nominee, vowed not to roll back protections for sick people.
John McDonough, a professor of public health at Harvard and a former Senate aide who advised the authors of the Affordable Care Act, said he thought the issue had developed potency in the last few years as more Americans came to value the protections the law had brought.
“I don’t think people really appreciated, back in 2008, 2009 and 2010, the role of pre-existing conditions and medical underwriting,” he said. “But there’s been a societal shift underway. American society has become committed to this notion that your ability to get medical coverage should not be conditioned on your medical history.”
It is far from certain that the House-approved, White House-backed legislation will become law in anything resembling its current form. Even if it did, it is unclear that states would actually seek to waive the most popular regulations protecting sick people.
Gov. Scott Walker of Wisconsin, a Republican, said Friday that he might be open to seeking such a waiver. But his was a lonely voice, and Malloy, of the Democratic governors’ group, leveled a taunting dare at Walker: “He should run on that.”
Joseph Antos, a health economist at the conservative American Enterprise Institute, said it was “very questionable” that any state would seek such a waiver.
“It’s an opportunity for great political risk,” Antos said. “Why would a state want to take full responsibility for anything that goes wrong, without being able to blame the federal government?”
Antos said he saw a parallel between some of the Democrats’ “overhyped” warnings and the fears stoked by Sarah Palin and other conservatives that the Affordable Care Act would lead to “death panels.”
“I’ve heard claims that Republicans don’t want your grandmother to have cancer treatment,” Antos said. “It’s pretty insane.”
But the warnings of death panels were blatantly false, while warnings about insurers again being able to price sick people out of the market could prove true, depending on the state.
The Kaiser Family Foundation, a nonpartisan research group, has estimated that 27 percent of Americans younger than 65 have health conditions that would likely leave them uninsurable if they applied for individual market coverage under the system that existed before the Affordable Care Act.