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Does the AHCA Exclude People with Pre-Existing Conditions?

Law book with a gavel - Health lawAs the American Health Care Act moves through Congress, many media outlets have published alarming stories regarding the potential changes to our national healthcare policy. You might have heard, for example, that anyone with a pre-existing condition will lose their health insurance as a result of the new laws, andably alarming, but hopefully we can offer you some peace of mind.

First, the Act has yet to become law, and edit certain portions of the Act. So, with regard to any fears, it’s best not to get too far ahead of ourselves.

But of course, it is normal to be concerned about whether your health insurance policy will be changing. So here’s what we know about the pre-existing conditions clause, so far.

If you get health insurance through Medicare, Medicaid, or employer-provided insurance, your health insurance would not change due to a pre-existing condition.

The AHCA does contain a provision, that allows states to seek a waiver from covering pre-existing conditions. If you purchase your insurance through the individual marketplace, and go uncovered for more than 63 days. In other words, so long as you re-enroll in your policy or select a new one during Open Enrollment, you would still be covered.

Only 18 million Americans currently purchase their health insurance through the individual marketplace. Among those, many live in blue states that are unlikely to seek the waiver. This new rule would only affect those living in states that receive the waiver, and who do not already have health insurance or who allow their coverage to lapse for more than 63 days.

In other words, the pre-existing condition clause will only affect you, depending upon what the state of California decides to do in response to the new law, and if you purchase your insurance through the individual marketplace.

In addition, if you fall into that small group of people and want to purchase health insurance, you can only be charged a higher premium for the first year.

To sum up, the AHCA does contain language that could make it more difficult for a very small number of people (with a pre-existing condition) to access health insurance. Most people with pre-existing conditions probably don’t need to worry.

Finally, the bill does not contain specific language about which conditions are excluded or covered. The term “pre-existing condition” would be defined more by insurance companies, than by the law itself.

But of course, nothing is set in stone yet. We’ll continue to update you on possible changes to healthcare law, and let you know how these changes affect you specifically.