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“October Surprise”: Trump Goes Straight After Pre-existing Conditions Protections in Latest Front of GOP War on Health Care

By October 23, 2018No Comments

“Trump’s ‘October Surprise’ is to prove once and for all that Republicans don’t care about protecting people with pre-existing conditions or making health care more affordable,” says Brad Woodhouse

Washington, DC – One year ago — after the American people rose up to defeat health care repeal — the Trump Administration issued an executive order outlining three ways that it would circumvent the will of the public and roll back health care protections in the Affordable Care Act. Today, the Trump administration has checked all three things off its list: this summer, it eased restrictions on junk plans (association health plans, or AHPs, and short-term health plans, or STLDIs); yesterday it made it easier for states to allow insurance companies to sell junk plans, and today it announced it has expanded health reimbursement arrangements (HRAs), over the overwhelming opposition of health care experts and advocates. In response, Brad Woodhouse, executive director of Protect Our Care, issued the following statement:

“It’s the trifecta of health care sabotage: not satisfied with just undermining protections for people with pre-existing conditions or pushing junk plans for individuals, now the Trump Administration is working to undermine comprehensive employer coverage, as well. Trump’s ‘October Surprise’ is to prove once and for all that Republicans don’t care about protecting people with pre-existing conditions or making health care more affordable. If we know one thing to be true, it’s that the GOP’s ongoing war on America’s health care isn’t slowing down — in fact, it’s on overdrive as long as they have power.”


Standalone HRAs By Definition Contain An Annual Limit and Are Not Required to Cover Certain Preventive Services. “The ACA requires group health plans to meet certain standards that HRAs can’t meet, specifically the ban on annual and lifetime limits and the requirement to cover certain preventive services at no cost to plan enrollees. (HRAs by definition contain an annual limit on the amount of the employer’s contribution, and they are just accounts that do not cover any benefits.)” [Center on Budget and Policy Priorities, 11/29/17]

Increasing Access To Standalone HRAs Could Incentivize Businesses To Offer Limited Coverage HRAs Instead Of Full Health Coverage. “If the Administration attempts to broaden the availability of such “standalone” HRAs, that would likely prompt fewer businesses to offer health coverage to their employees.  Workers who now have good coverage and substantial contributions from an employer could see those benefits dropped and replaced with an HRA that leaves them paying higher premiums for less comprehensive coverage than what they have today.” [Center on Budget and Policy Priorities, 11/29/17]

HRAs Could Raise Premiums in the Individual Market By Drawing Healthy People Out Of Individual Market. “Depending on the specific proposals, and what employers do in response, HRAs could negatively affect the individual market by moving more high-cost people into that risk pool, raising overall premiums, and leaving other individual-market consumers and the federal government (through the premium tax credit) paying more.” [Center on Budget and Policy Priorities, 11/29/17]

American Cancer Society Cancer Action Network, American Heart Association, America’s Health Insurance plans, Blue Cross Blue Shield Association, Center on Budget and Policy Priorities, Crohn’s & Colitis Foundation, Epilepsy Foundation, Families USA, March of Dimes, The National Multiple Sclerosis Society Are Opposed to Expanding HRAs: “Expanding and extending short-term, limited-duration health plans, increasing enrollment in Association Health Plans (AHPs), and relaxing rules for employer Health Reimbursement Arrangements (HRAs) all increase adverse selection in insurance markets that serve millions of individuals and employers. We are concerned that this could create or expand alternative, parallel markets for health coverage, which would lead to higher premiums for consumers, particularly those with pre-existing conditions. Further, these actions destabilize the health insurance markets that guarantee access to comprehensive health coverage regardless of health status.” [Letter to State Departments of Insurance, 12/14/17]


  • Protections for people with pre-existing conditions would be essentially meaningless. The American Cancer Society Cancer Action Network said allowing states to waive essential health benefits “could render those protections meaningless” for people with pre-existing conditions.
  • It would be harder for people with pre-existing conditions to get affordable coverage. As Consumers Union stated, allowing states to waive essential health benefits would be “putting meaningful coverage out of reach for many Americans, especially those with chronic and pre-existing conditions.”
  • You could pay more for the same coverage. 1332 waivers allow states to adjust the amount of premium tax credits and cost-sharing consumers receive to help lower their costs. Without the guardrail to ensure coverage is just as affordable, many consumers could end up paying more for the same care.
  • Insurers would not have to cover essential benefits, like maternity care. Right now, every insurance plan must cover the 10 essential health benefits. Because states could opt out of covering these basic benefits, insurers would likely only offer policies that covered much less than they do now. The Kaiser Family Foundation found that the benefits most likely to no longer be covered would be maternity care, mental health or substance abuse coverage. According to the Brookings Institution, the result would be “that no one in a state’s individual market that waived EHBs would have access to comprehensive coverage. Insurers would likely sell separate policies for benefits not covered in their core plan offerings, but these supplemental policies would be subject to tremendous adverse selection, leading to very high premiums and enrollment almost exclusively by those with pre-existing conditions.” For example, a woman who purchases a separate insurance rider for maternity care would have to pay $17,320 more, according to the Center for American Progress. For states that no longer required substance use disorders or mental health to be covered, coverage for drug dependence treatment could cost an extra $20,450.
  • Insurers could reimpose lifetime and annual limits. Allowing states to opt out of the essential health benefits coverage means that insurance companies could once again put lifetime and annual limits on the amount of care you receive. Moreover, as the Center on Budget and Policy Priorities notes, this would even impact people with coverage from their employer: “The ACA’s prohibition on annual and lifetime limits is tied to the definition of Essential Health Benefits. Thus, repeal of Essential Health Benefit standards could make this protection meaningless, putting almost all Americans with private health insurance coverage — not just those with individual or small-group market coverage — at risk.” The Center for American Progress estimates that 20 million people with health coverage through their employer would face lifetime limits on coverage, and 27 million would face annual limits.


Short-Term Junk Plans Can Refuse To Cover Essential Health Benefits. “Typical short-term policies do not cover maternity care, prescription drugs, mental health care, preventive care, and other essential benefits, and may limit coverage in other ways.” [Kaiser Family Foundation, 2/9/18]

Short-Term Plans May Exclude Coverage For Pre-Existing Conditions. “Policyholders who get sick may be investigated by the insurer to determine whether the newly-diagnosed condition could be considered pre-existing and so excluded from coverage.” [Kaiser Family Foundation, 2/9/18]

  • As Many As 130 Million Nonelderly Americans Have A Pre-Existing Condition. [Center for American Progress, 4/5/17]
  • One in 4 Children Would Be Impacted If Insurance Companies Could Deny Coverage Or Charge More Because Of A Pre-existing Condition. [Center for American Progress, 4/5/17]

Junk Plans Mean Higher Premiums For People With Pre-Existing Conditions. “By promoting short-term policies, the administration is making a trade-off: lower premiums and less coverage for healthy people, and higher premiums for people with preexisting conditions who need more comprehensive coverage.” [Washington Post, 5/1/18]

Under Many Short-Term Junk Plans, Benefits Are Capped At $1 Million Or Less. Short-term plans can impose lifetime and annual limits –  “for example, many policies cap covered benefits at $1 million or less.” [Kaiser Family Foundation, 2/9/18]