The current Senate Republican health care repeal bill already puts health insurance at risk for those with pre-existing conditions.

Now, to appease the far right wing in the Senate, Republican leaders are considering making it even worse.

In the House of Representatives, Republicans gutted protections for people with pre-existing conditions by allowing states to opt out of them. The Senate Republicans promised they wouldn’t do that but they are now pushing Ted Cruz’s plan that allows the insurance companies to opt out instead. Either way, the result is the same: people with pre-existing conditions who depend on their health care will lose these protections and pay more for worse coverage.

Here’s what the proposal would really mean:

THE CRUZ PROPOSAL WOULD GUT CONSUMER PROTECTIONS LIKE GETTING RID OF ANNUAL AND LIFETIME LIMITS

Sen. Chuck Grassley (R-IA): “There’s A Real Feeling That That’s Subterfuge To Get Around Pre-Existing Conditions.” “‘There’s a real feeling that that’s subterfuge to get around pre-existing conditions,’ says Grassley. ‘If it is subterfuge and it has the effect of annihilating the pre-existing condition requirement that we have in the existing bill, than obviously I would object to that.’” [Iowa Public Radio, 7/5/17]

Sen. Shelley Moore Capito (R-WV): Cruz Amendment “Would Make It Too Difficult For People With Pre-Existing Conditions To Get Coverage.” “‘I think that reopens an issue that I can’t support, that it would make it too difficult for people with pre-existing conditions to get coverage,’ she said.” [Charleston Gazette-Mail, 7/8/17]

Sen. Susan Collins (R-ME): “It Would Lead To Adverse Selection In The Marketplace, And It Would Vitiate The Important Consumer Protection Of Having A Prohibition Against Annual And Lifetime Caps.” “‘It would lead to adverse selection in the marketplace, and it would vitiate the important consumer protection of having a prohibition against annual and lifetime caps,’ Senator Susan Collins of Maine said in an interview.” [Bloomberg, 6/29/17]

Sen. Susan Collins (R-ME): “It Would Erode Protections For People With Pre-Existing Conditions, And It Is Simply Not The Answer.” “‘I have a lot of concerns about Sen. Cruz’s amendment,’ she said. ‘It would erode protections for people with pre-existing conditions, and it is simply not the answer. I think it would cause premiums to go up for a lot of people.’” [Washington Examiner, 7/11/17]

THE CRUZ PROPOSAL WOULD DESTABILIZE THE MARKETPLACE AND LEAD TO A DEATH SPIRAL

Larry Levitt, Senior Vice President, Kaiser Family Foundation: Cruz Plan “The Perfect Recipe For Destabilizing The Market And Turning The Marketplaces Into High-Risk Pools.” “‘If there were a Joy of Cooking for insurance, this would be the perfect recipe for destabilizing the market and turning the marketplaces into high-risk pools,’ said Larry Levitt, senior vice president at the Kaiser Family Foundation.” [CNN Money, 7/6/17]

Larry Levitt, Senior Vice President, Kaiser Family Foundation: “Segmenting The Risk Pool Is Inherently Destabilizing.” “‘Segmenting the risk pool is inherently destabilizing,’ he said, pointing out that individuals who make too much money to qualify for subsidies would likely face a particularly grim situation. ‘They wouldn’t be able to get noncompliant plans because of their medical conditions and would face astronomical premiums in the compliant market.’” [Politico, 7/11/17]

Douglas Holtz-Eakin, Former Director, Congressional Budget Office Director, And President, American Action Forum: “That’s A Recipe For A Meltdown.” “‘What that will do is allow insurers to offer cheap policy to young invincibles. And on the exchange you’re going to get all the sick people,’ said Douglas Holtz-Eakin, a former Congressional Budget Office director and president of the American Action Forum. ‘That’s a recipe for a meltdown. You’ve split the risk pool into two exchanges.’ And, he added: ‘I think it would end up being bad politics.’” [Politico, 7/1/17]

Tara O’Neill Hayes, Deputy Director Of Health Care Policy, American Action Forum: “I Think That Really Would Be The Definition Of A Death Spiral.” “‘I think that really would be the definition of a death spiral,’ said Tara O’Neill Hayes, deputy director of health care policy at the conservative American Action Forum. ‘I think it would no longer be a question of whether that’s happening.’” [Politico, 7/11/17]

Insurance Industry Official: “Insurers Are Concerned That Would Make It Challenging To Keep Premiums Low For Everyone.” “Insurance groups and policy experts warn, however, that this approach would create instability in the individual market by fragmenting the risk pool and driving up premiums for sicker people who need expensive care. They say it would turn the market for ACA-compliant plans into a de facto high-risk pool, but without an adequate, dedicated funding stream to make that model viable. ‘Insurers are concerned that would make it challenging to keep premiums low for everyone,’ said an insurance industry official who did not want to be named.” [Modern Healthcare, 6/30/17]

Craig Garthwaite, Health Insurance Expert, Northwestern University: “The Sick Would Be Attracted To Cheaper Plans, With The Knowledge They Could Always Move Into More Generous Plans If They Got Sick.” “‘The sick would be attracted to generous plans, while the healthy would be attracted to cheaper plans, with the knowledge they could always move into more generous plans if they got sick,’ said Craig Garthwaite, a health insurance expert at Northwestern University. ‘That kind of adverse selection makes pricing and offering insurance very hard.’” [Modern Healthcare, 6/30/17]

Vox: “The Fundamental Problem Is Sicker People Would Be Drawn To The More Robust Obamacare Plans, While Healthier People Would Gravitate Toward The Skimpier Non-Obamacare Coverage.” “The fundamental problem is sicker people would be drawn to the more robust Obamacare plans, while healthier people would gravitate toward the skimpier non-Obamacare coverage. That’s a reality that even Cruz acknowledges. Then inside the Obamacare market, as more and more sick people buy coverage there, costs for health insurers go up and so they increase premiums. It has the makings of a classic death spiral. Because only sick people remain, premiums eventually increase to astronomic levels. It turns the Obamacare exchanges into a high-risk pool.” [Vox, 6/29/17]

Vox: “The Whole Idea Is Dependent On An Effectively Unlimited Federal Commitment To Pay The Bills.” “So it becomes a question of the federal government’s willingness to pay that bill, indefinitely into the future. Otherwise, people with high medical costs could be stuck with a market that doesn’t function and isn’t adequately subsidized. The whole idea is dependent on an effectively unlimited federal commitment to pay the bills.” [Vox, 6/29/17]

Larry Levitt, Senior Vice President, Kaiser Family Foundation: “How Long Would Congress Allow The ACA Tax Credits To Stand As The Costs Increase Rapidly?” “‘The marketplaces would turn into de facto high-risk pools,’ Levitt said. ‘How long would Congress allow the ACA tax credits to stand as the costs increase rapidly?’” [Vox, 6/29/17]

THE CRUZ PROPOSAL WOULD RAISE COSTS FOR PEOPLE WITH PRE-EXISTING CONDITIONS

Sen. Susan Collins (R-ME): “His Proposal Would Lead To Unaffordable Rates For People With Pre-Existing Conditions.” “His proposal would lead to unaffordable rates for people with pre-existing conditions. It would result in the re-imposition of annual caps on how much your insurance will cover, which will be devastating for people who develop or have a chronic, expensive disease to treat. And it would call into question whether someone with preexisting conditions could even buy insurance, so I do not support his plan.” [Associated Press, 7/10/17]

Ceci Connolly, CEO, Alliance Of Community Health Plans: “You Are Increasing The Likelihood That There Will Be Some Smaller, Sicker Group With Higher Rates.” “Separating the sick and the healthy is ‘not the best path forward,’ said Ceci Connolly, CEO of Alliance of Community Health Plans, a lobbying group for non-profit, community-based insurers. Instead, it’s better to spread the risk around in a larger pools of enrollees. The Cruz option would do the opposite. ‘You are increasing the likelihood that there will be some smaller, sicker group with higher rates,’ Connolly said. ‘That’s what you want to get away from.’” [CNN Money, 7/6/17]

Larry Levitt, Senior Vice President, Kaiser Family Foundation: “If They Have Pre-Existing Conditions, They’d Be Stuck In Plans With Escalating Premiums.” “Americans with higher incomes who wanted to buy an Obamacare-compliant plan, people likely to have high medical costs themselves, would have no protection from skyrocketing premiums. ‘If they’re healthy, they could buy inexpensive non-compliant plans. But if they have pre-existing conditions, they’d be stuck in plans with escalating premiums,’ Levitt said.” [Vox, 6/29/17]

Tim Jost, Law Professor, Washington And Lee University: “If This Were Adopted, Premiums Would Skyrocket For People Who Need Comprehensive Coverage.” “Health analysts said the amendment would cause premiums for that demographic to jump, resurrecting a thorny political issue that drew national attention earlier this year when House Republicans added a similar measure to their bill, known as the MacArthur amendment. ‘If this were adopted, premiums would skyrocket for people who need comprehensive coverage,’ said Timothy Jost, a law professor at Washington and Lee University in Lexington, Va.” [Wall Street Journal, 7/5/17]

Joe Antos, Health Policy Expert, American Enterprise Institute: People With Chronic Illness “Will End Up Paying More.” “‘Someone with chronic illness, they’re going to end up wanting to buy the more comprehensive coverage,’ says Joe Antos, a health policy expert with the conservative American Enterprise Institute. ‘This means that people with those kinds of illnesses will end up paying more. Even if they receive a federal subsidy, they will likely see higher cost sharing.’ … ‘The people who don’t know something will happen and come down with something, those are the ones at issue,’ Antos argues. ‘It’s not the people who planned ahead and bought the more expensive plan. It’s those who didn’t.’” [Vox, 7/10/17]

Wall Street Journal: “Middle-Income Earners With Pre-Existing Conditions Would Be The Hardest Hit.” “Such a bifurcation likely would mean increased costs for comprehensive plans, analysts said. People receiving the bill’s tax credits would be buffered from the price increases, but those who earn 350% of the poverty level and wouldn’t be eligible for the credits would pay more, they said. Middle-income earners with pre-existing conditions would be the hardest hit.” [Wall Street Journal, 7/5/17]

Larry Levitt, Senior Vice President, Kaiser Family Foundation: Getting Premiums Down “Comes Down To Relaxing Rules That Protect People With Pre-Existing Conditions.” “‘When it gets to crunchtime on these health bills, the discussion comes down to getting premiums down,’ said Larry Levitt, a senior vice president at Kaiser Family Foundation. ‘And that comes down to relaxing rules that protect people with pre-existing conditions.’” [Wall Street Journal, 7/5/17]