If there was one goal Senate Republicans had set out to achieve in developing their health bill to show they were less “mean” than their colleagues in the House, it was to take away the House Republicans’ green light for insurers to once again discriminate against those with pre-existing health conditions. Senate Republicans were willing to drive up deductibles and co-pays and be more draconian on Medicaid cuts, but on the one issue of pre-existing conditions they were intent on being less “mean,” as President Trump termed the House bill. Now that the text of the bill has been released, it’s clear that they have failed to achieve that.
As they argue for the bill, Republicans are going to claim that it will not allow insurance plans to discriminate against people because they have a pre-existing condition. But that just isn’t the case. The Republican plan may not allow insurers to discriminate against a pre-existing condition through the front door, but they’ve created a backdoor way in.
So what is this backdoor for discriminating against those with pre-existing conditions and how does it work?
Answering that question requires understanding the importance of a key protection in the Affordable Care Act, what is known as the “Essential Health Benefits” requirement. These Essential Health Benefits rules require insurance companies to cover critical care, such as treatment by doctors, hospital stays, and prescription-drug costs. The guarantee of Essential Health Benefits means that no insurer can provide any health plan that excludes these critical benefits. Perhaps it goes without saying, but if these benefits are not covered, a plan is all but worthless to those with serious pre-existing conditions.