Immediately following the vote on the House GOP’s American Health Care Act (AHCA), misinformation about the bill began spreading like wildfire, stoking fears and outrage. The issue which seems to be getting the most attention is the potential impact this legislation could have on people with pre-existing conditions.

Under AHCA, the federal guaranteed issue requirement would NOT be repealed, meaning that insurers in every state would still be prohibited from denying insurance coverage to anyone on the basis of a pre-existing condition. In no circumstance would this protection be denied, though it seems much confusion surrounding this protection has stemmed from the adoption of several amendments to the underlying legislation. It is unlikely that many Americans will be impacted by the provisions of one particular amendment in question, the MacArthur amendment. It is also important to remember that the AHCA must still be passed by the Senate and is likely to undergo significant reforms before it does, in which case, the legislation would again have to be passed by the House.

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If you’ve only followed coverage of the Republican health-care bill loosely in the media, you might believe that House Republicans, after much effort, passed legislation to deny people with pre-existing conditions health insurance. The issue of pre-existing conditions has dominated the debate over the GOP health-care bill out of all proportion to the relatively modest provision in the legislation, which is being distorted — often willfully, sometimes ignorantly — into a threat to all that is good and true in America. The perversity of it all is that the legislation is properly understood as doing more to preserve the Obamacare regulation on pre-existing conditions than to undermine it.

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Aetna Inc. is quitting Virginia’s Obamacare market for 2018, the second state that Chief Executive Officer Mark Bertolini is exiting as he seeks to limit his insurer’s risks from the beleaguered health law.

“We will not offer on- or off-exchange individual plans in Virginia,” Aetna said in an emailed statement, citing $200 million or more in losses the company anticipates this year on individual products. The insurer also cited “growing uncertainty in the marketplace” for the plans.

UnitedHealth Group Inc., which has largely stopped selling ACA health plans, said last month it was pulling out of Virginia. Also in April, Aetna said it wouldn’t sell Obamacare plans on Iowa’s market next year.

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The Republican predicament is illustrated in the cultural response to a monologue by late-night host Jimmy Kimmel who, through tears, made an impassioned plea to President Donald Trump and the GOP not to decrease public funding for or access to health insurance.

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Aetna Inc. will again scale back its presence in the Affordable Care Act exchanges in 2018, saying it expects losses on the business this year.

Individual plans are a small share of Aetna’s overall business, and the insurer had already scaled back its exchange presence to four ACA marketplaces currently, down from 15 last year.

Aetna said it expects 2017 losses on its individual business will amount to roughly half its loss last year, which was $450 million.

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House conservatives rebelled over the original version of the American Health Care Act, which only partially deregulated insurance markets. The bill maintained the rule known as guaranteed issue, which requires insurers to cover all applicants regardless of medical history. It also relaxed community rating, which limits how much premiums can vary among beneficiaries.

The media and the left thus claim that conservatives want to allow insurers to charge sick people more, and some conservatives agree, which spooks the moderates. But the latest compromise between conservatives and centrists doesn’t repeal guaranteed issue or community rating. It keeps these regulations as the default baseline, and states could apply for a federal waiver if they want to pursue other regulatory relief.

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President Donald Trump said Monday the Republican health-care bill being negotiated in Congress ultimately will protect Americans with pre-existing conditions as well as Obamacare does.

“I want it to be good for sick people. It’s not in its final form right now,” he said during an Oval Office interview Monday with Bloomberg News. “It will be every bit as good on pre-existing conditions as Obamacare.”

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There’s no way around a simple truth: treating an expensive health condition costs (someone) lots of money.  There are four basic approaches that can be taken to this problem:  1) Leave sick people to face the costs of their own treatment, whether out of pocket or through high-cost insurance, no matter how ruinous those costs become;  2) Mandate that other, healthier people overpay for the value of their own health insurance, so that sick people can underpay for the value of theirs;  3) Spread the costs of paying expensive health bills throughout society, for example by having taxpayers pick up the tab; and  4) Require a targeted group to shoulder the costs.  [The AHCA opts for 3).]
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As House Republicans regain momentum in their quest to replace Obamacare, GOP moderates have done something unexpected: they’ve focused not broadly on covering the uninsured, but specifically on protecting those with pre-existing conditions. There’s a reason for that, and it has to do with wildly exaggerated claims that Democrats made when they were passing the law in 2009 and 2010.

The vast majority of Americans who are uninsured aren’t without coverage because of a health problem. They’re uninsured because of an economic problem: the problem that American health care costs too much, especially for lower-middle-income Americans who earn too much to qualify for government assistance.

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As Members of Congress debate repealing and replacing Obamacare, they should learn from the failures of that law in crafting a better set of health care policies. One important step in that crafting is the establishment of a fairer and more reasonable set of rules for limiting health plans’ application of pre-existing condition exclusions. Policymakers should link the ban on exclusions for pre-existing conditions to a requirement of continuous coverage. Setting the right rules around the prohibition on plans applying pre-existing condition exclusions will not only stabilize insurance markets, but also provide a firmer foundation for future reforms of other aspects of health care policy.
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