WASHINGTON — In the debate over how the effort to replace the Affordable Care Act would affect those with pre-existing health conditions, opponents and supporters alike have offered misleading talking points.
Faced with polling indicating public support for protections, and after an emotional appeal by the television host Jimmy Kimmel that has gone viral, Republicans are making a dubious case that their updated bill provides similar coverage for those who are less healthy, while Democrats are overstating claims about how many are affected.
Here’s an assessment:
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Speaker Paul D. Ryan said the bill protects people with pre-existing conditions.
“VERIFIED: The MacArthur amendment protects people with pre-existing conditions. The amendment is very clear: Under no circumstance can people be denied coverage because of a pre-existing condition.”
This is misleading. The amendment offered by Representative Tom MacArthur, Republican of New Jersey, prohibits denying coverage to people with a pre-existing condition, but, importantly, it does not shield against potentially higher costs.
Under the Affordable Care Act, insurers are required to charge the same price for coverage regardless of health status, a practice known as community rating. The amended Republican bill, Mr. Ryan said in a news release, allows states to waive this rule for those with lapses in coverage, though it mandates that they provide “risk-sharing or reinsurance mechanisms.”
These include high-risk pools, subsidies and a program to reimburse insurers for sicker patients. Similar mechanisms that existed before the Affordable Care Act covered few people and were underfunded, The New York Times reported.
Joseph Antos, a health economist at the conservative American Enterprise Institute, said Mr. Ryan’s claim is “technically correct, but it’s not the same thing as providing the same promise as the A.C.A. has made.”
Representative Steve Scalise, Republican of Louisiana, suggested the bill’s protections are more robust than those provided by the Affordable Care Act.
“It actually provides multiple layers of protection for people with pre-existing conditions in ways that Obamacare doesn’t do.”
False. The bill’s provisions on pre-existing conditions are certainly more complicated, but the two ways Mr. Scalise listed — prohibiting discrimination for those with continuous coverage, and high-risk pools — are not more protective than the Affordable Care Act.
Many people with pre-existing conditions experience lapses in coverage, such as when they change jobs, for example. Once they do and are priced out of the pool of healthier people, they “may find coverage unaffordable,” said Timothy Jost, an expert on health law at Washington and Lee University.
The bill does say that states must provide alternatives in lieu of community rating, but experts have said high-risk pools and the other options outlined provide a lot of leeway for pricing and benefits, and do not necessarily mandate coverage for people who cannot afford it because of pre-existing conditions.
A spokesman for Mr. Scalise said that, in addition to numerous funding mechanisms for pre-existing conditions (which experts have said are inadequate), the repeal bill is better because insurers are exiting the A.C.A. so “if there is no one to sell insurance, no one with or without pre-existing conditions can get it.”
Over all, the bill is also worse for older and sicker people, and its “skimpier subsidies and Medicaid cuts” could actually push people toward gaps in coverage, said Sabrina Corlette, a research professor at Georgetown University, adding that Mr. Scalise’s claim is “utter nonsense.”
Representative Nancy Pelosi, Democrat of California, said the Affordable Care Act insured 17 million children with pre-existing conditions.
“Up to 17 million children who have pre-existing conditions can no longer be denied coverage by insurers.”
This is misleading. Ms. Pelosi’s office cited a 2011 Department of Health and Human Services report, but the 17 million figure is the upper limit of the department’s estimates. The report’s lower figure, four million, is a fraction of that, and most of those children already had coverage before the Affordable Care Act.
It was less common for insurers to deny coverage to children with pre-existing conditions, such as Mr. Kimmel’s son, than to their adult peers, Larry Levitt of the Kaiser Family Foundation said. “But it certainly did happen,” he said.
Representative Frank Pallone Jr., Democrat of New Jersey, criticized the bill as hurting 129 million people with pre-existing conditions.
“The current version of Trumpcare allows insurance companies to discriminate against the 129 million Americans with pre-existing conditions.”
This is misleading. The Committee on Energy and Commerce, on which Mr. Pallone is the ranking Democrat, also cited the health and human services report, and his figure highlights the most drastic findings.
The low end of the estimate was 50 million, a little more than one-third of Mr. Pallone’s figure. Most people with pre-existing conditions also have insurance through their employers (as many as 82 million, according to the same health and human services report), and would not be directly affected by the bill’s changes to pre-existing conditions. Others were covered through public options such as Medicaid, so Mr. Pallone’s and Ms. Pelosi’s claims are “baffling,” Mr. Antos said.
Even for those in the individual market, the scope of the bill’s impact is difficult to predict because it is impossible to determine how many people would experience gaps in coverage, and how many states would choose to waive community rating.
In the worst-case scenario — extrapolating a Kaiser analysis that found 27 percent of Americans under 65 had conditions that left them uninsurable — about 4.7 million people with pre-existing conditions could be affected, Mr. Levitt said.