Q: Are sexual assault and rape preexisting conditions under the GOP health bill?
A: No. The bill doesn’t identify any preexisting conditions, and it says insurers can’t deny coverage to individuals who have them. But insurers could charge more for medical conditions in certain cases.
FULL QUESTION
Would rape be considered a preexisting condition under the GOP’s new health care bill?
FULL ANSWER
House Republicans’ American Health Care Act does not say that sexual assault, rape, domestic violence or any other act or illness is a preexisting condition. States and insurance companies would be the ones to decide what constitutes a preexisting condition. And nearly all states have laws prohibiting insurance discrimination for domestic and/or sexual violence.
Questions from our readers, like the one above, were prompted in part by inaccurate headlines on news stories that recalled a time not long ago when insurers could decline to offer insurance, or could charge more, to individuals with costly medical conditions.
For example, a since-corrected headline on a May 4 New York Magazine blog post said that “In Trump’s America, Rape Is a Preexisting Condition.” The article linked to a 2009 Huffington Post story about a 45-year-old woman, Christina Turner, who had a hard time obtaining health coverage after she was raped and insurers became aware that she had been taking a medication to prevent HIV infection.
But that was before the Affordable Care Act was signed into law in 2010. And since 2014, insurers have been prohibited from denying coverage to anyone based on health status.
To be clear, the GOP bill that passed in the House on May 4 would not change that.
As a Kaiser Family Foundation summary of the GOP bill says, it retains the “requirement to guarantee issue coverage” — which means coverage must be offered regardless of health status — and it retains the “prohibition on pre-existing condition exclusions” — which forbids insurers from excluding coverage specifically for a policyholder’s preexisting conditions.
But, under the GOP bill, some states could choose to allow insurers to charge more on the individual market based on preexisting conditions in some cases. And some critics of the AHCA have said, if the bill became law, it’s possible that some people could be charged more for insurance based on health issues that were the result of a sexual assault or rape, such as post-traumatic stress disorder or a sexually transmitted disease.
As introduced, the bill said that insurers on the individual market are required to charge a 30 percent higher premium for one year, regardless of health status, to those buying their own insurance who had a lapse in coverage of 63 days or more during the previous 12 months.
However, an amendment from Rep. Tom MacArthur that was added to the bill allows states to obtain a waiver from the Department of Health and Human Services enabling insurers to charge even higher premiums to people with preexisting conditions who didn’t maintain continuous coverage. Those policyholders could be charged more based on health status for one year. If they avoided another 63-day gap in coverage, they would get a less expensive premium that was not based on health status.
As we’ve explained before, to get a waiver, a state would have to have either a “risk mitigation program,” such as a high-risk pool, or participate in a new Federal Invisible Risk Sharing Program, as a House summary of the amendment says. Although insurers could consider “health status” in those instances, a House Energy and Commerce Committee aide told us that there would still be protections against using domestic violence or mental conditions in insurance underwriting. In addition, lawmakers added to the bill $8 billion in federal money over five years to financially aid those with preexisting conditions who find themselves facing higher premiums in waiver states.
So, if the bill became law, it could potentially affect people with some medical conditions, including those due to sexual assault or rape. But only if they purchase their own insurance on the individual market, have a lapse of coverage of at least 63 days and also live in a state that is granted a waiver — and in a state that doesn’t have a law that would prohibit insurance discrimination for sexual assault.
But that’s different from wrongly claiming that the AHCA makes rape and sexual assault preexisting conditions and outright denies coverage to victims.
We’d also note that most Americans would not be affected by that provision if the bill became law. While an estimated 27 percent of nonelderly Americans have some kind of preexisting condition, according to the Kaiser Family Foundation, only 7 percent of the total population buys insurance on the individual market, according to a 2015 estimate. The rest of Americans get coverage through their employers or a public program like Medicaid.
And as of this year, all but three states – Idaho, North Dakota and Vermont — had enacted laws to prevent insurers from discriminating against victims of sexual assault or domestic violence, according to an analysis by the National Association of Insurance Commissioners. A 2012 report funded by the Department of Health and Human Services on domestic violence and health care says that “state laws vary widely in scope of coverage, including types of insurance to which they apply, types of practices prohibited, and remedies provided.”
It’s unknown whether Republicans in the Senate would retain the state waiver provision in their health care bill. They are likely to make changes to the House bill if not write their own legislation.
Sources
Kaiser Family Foundation. “Summary of the American Health Care Act .” Accessed 9 May 2017.
Robertson, Lori. “The Preexisting Conditions Debate.” FactCheck.org. 4 May 2017.
Robertson, Lori, et al. “The Facts on the GOP Health Care Bill.” FactCheck.org. 8 Mar 2017.
Claxton, Gary, et al. “Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA.” Kaiser Family Foundation. 12 Dec 2016.
Kaiser Family Foundation. Health Insurance Coverage of the Total Population. Accessed 9 May 2017.
U.S. House. “H.R.1628, American Health Care Act.” (as introduced by the House 20 Mar 2017.)
U.S. House. “H.R.1628, American Health Care Act.” (as passed by the House 4 May 2017.)
U.S. House Committee on Energy and Commerce. Amendment to H.R. 1628 Offered by Mr. MacArthur, Section-by-Section Summary. 24 Apr 2017.
Spellings, Sarah. “In Trump’s America, Being Sexually Assaulted Could Make Your Health Insurance More Expensive.” NYMag.com. 4 May 2017.
Solis, Marie. “Under the GOP’s health plan, sexual assault could be considered a pre-existing condition.” Mic.com. 3 May 2017.
Wellman, Nathan. “Under Trumpcare plan, rape would be considered a pre-existing condition.” Resistance Report. 3 May 2017.
Mendoza, Samantha. “How Is Rape A “Preexisting Condition”? The AHCA Should Infuriate Women.” Bustle.com. 5 May 2017.
Sable-smith, Bram. “GOP Health Bill Leaves Many ‘Pre-Existing Condition’ Protections Up To States.” NPR. 8 May 2017.
Ivory, Danielle. “Rape Is a Pre-Existing Condition? The Heartlessness of the Health Insurance Industry Exposed.” Huffington Post Investigative Fund. 21 Oct 2009.
Ye Hee Lee, Michelle. “Despite critics’ claims, the GOP health bill doesn’t classify rape or sexual assault as a preexisting condition.” Washington Post Fact Checker. 6 May 2017.