Trumpcare and Pre-Existing Conditions

Updated 5/16/2017

Trumpcare & Pre-Existing Conditions – The Most Common Conditions That Most Likely Will Not Be Covered

You may have read or heard discussions in the news lately about pre-existing conditions, and what Trumpcare might mean for anyone with one of them. First of all, it’s a very long list, but being the pragmatic individuals we are, and knowing that there’s only so much people will read, we’ve distilled the massive list of likely pre-existing conditions, down to the ones that are more common within the United States as of 2017.

Trumpcare & The Most Common Pre-Existing Conditions

Before the Affordable Care Act (ACA or Obamacare) took effect, insurance companies could choose to not accept applicants based on their medical history. It’s a practice known as medical underwriting, whereby insurers tally up your medical past and determine whether you’re insurable or not. Underwriting exists in all insurance fields, not just healthcare, but medical underwriting can be particularly damaging to people with certain medical problems.

Chronic conditions can be expensive to treat and live with. Prior to the ACA, people with pre-existing conditions – ranging from IBS to kidney failure – could be denied the coverage that they needed to manage their conditions. Those who found plans often paid substantially higher premiums than their healthy peers.

Under the American Health Care Act, which passed the U.S. House on May 4, 2017, insurance companies could charge higher premium rates to people with pre-existing conditions if those applicants allow their coverage to lapse. If you have a medical problem, such as diabetes, and you lose your health insurance, then you could pay a higher premium the next time you enroll. How much more? That depends on the insurer since each company sets its own rates, and there’s no limit in the AHCA that would prevent you from paying 100 percent more – or higher.

Premium Hikes for Pre-Existing Conditions

Before the ACA was passed, insurers might have charged someone with depression 50 percent more in premiums than someone without it, and being overweight could have resulted in a 25 percent surcharge. An analysis from outlines how much costlier health plans could be under Trumpcare with a surcharge for pre-existing conditions. Here are just a few examples:

  • Asthma: 106% surcharge ($4,340)
  • Autistic disorder: 135% surcharge ($5,510)
  • Diabetes (uncomplicated): 137% surcharge ($5,600)
  • Seizure disorders: 179% surcharge ($7,300)
  • Major depressive and bipolar disorders: 208% surcharge ($8,490)

These figures represent only the surcharge, which would be added to the standard premium for a healthy person. The surcharges listed above don’t include any assistance programs that might be implemented under Trumpcare (though the analysis from American Progress does list adjusted rates). In one extreme example, people with metastatic cancer could face a premium surcharge of 3,500 percent – an extra $142,650 per year for coverage on top of regular premiums and undoubtedly high medical bills.

The AHCA only allows states to charge higher premiums for people with pre-existing conditions if the states set up high-risk pools to offset the cost. Likewise, the federal government is allotting about $130 billion over the next nine years toward a Patient and State Stability Fund. Critics argue that this fund – and other so-called “invisible risk-sharing” methods – isn’t enough to help people with higher premiums afford coverage. The people who need more medical care may not be able to afford it under Trumpcare.

More Common That You Think

You might be thinking, “I don’t have a medical problem, so this doesn’t concern me.” Think again. Kaiser Family Foundation analyzed pre-ACA medical underwriting practices nationwide and determined that about 27 percent of U.S. adults have a condition that would make them uninsurable under the old guidelines. We’ve outlined 25 conditions that could count as “pre-existing” under Trumpcare in a handy infographic, along with how common they are among the U.S. population. To learn more about the prevalence of these conditions, check out our source links:

acid reflux | adult acne | anxiety | arthritis | asthma | C-section | cancer | COPD | depression | diabetes | disability | eating disorders | heart disease | high blood pressure | high cholesterol | infertility | kidney disease | mental disorders | migraines | obesity | paralysis | peptic ulcers | pregnancy | postpartum depression | sleep apnea

Our infographic doesn’t include every condition that an insurance company might consider “pre-existing.” In fact, it’s not even close.

Under pre-ACA rules, insurance companies could define their own set of standards for medical underwriting. Some insurers set stricter guidelines than others. If you have one of the following conditions or medical problems, then you may be subject to medical underwriting if you let your coverage lapse under Trumpcare:

  • Acid reflux
  • Acne (adult)
  • Acromegaly
  • ADD or ADHD
  • Alcohol abuse or drug abuse with recent treatment
  • Alzheimer’s or dementia
  • Amyotrophic Lateral Sclerosis (ALS)
  • Anemia (aplastic, Cooley’s, hemolytic, Mediterranean or sickle cell)
  • Anorexia
  • Anxiety
  • Aortic or mitral valve stenosis
  • Arteriosclerosis
  • Arthritis (rheumatoid), fibromyalgia, or other inflammatory joint diseases
  • Asbestosis
  • Asthma
  • Cancer within a set period (10 years, in some cases)
  • Cardiomyopathy
  • Celiac disease
  • Cerebral palsy
  • Chronic bronchitis in the past 12 months
  • Chronic obstructive pulmonary disease (COPD) or emphysema
  • Cirrhosis of the liver
  • Coagulation defects
  • Congestive heart failure
  • Coronary artery or heart disease, or bypass surgery
  • Crohn’s disease or ulcerative colitis
  • C-section
  • Cystic fibrosis
  • Demyelinating disease
  • Depression
  • Dermatomyositis
  • Diabetes
  • Diabetes mellitus
  • Dialysis
  • Disability (various)
  • Epilepsy
  • Esophageal varicosities
  • Friedreich’s ataxia
  • Glaucoma
  • Heart disease
  • Heartburn
  • Hemophilia
  • Hepatitis (Type B, C or chronic)
  • High blood pressure (hypertension)
  • High cholesterol
  • Hysterectomy
  • Infertility
  • Kidney disease or renal failure
  • Kidney stones
  • Knee surgery
  • Lupus
  • Lyme disease
  • Melanoma skin cancer
  • Menstrual irregularities
  • Mental disorders (including severe depression, anxiety, bipolar disorder, OCD, eating disorders and schizophrenia)
  • Migraines
  • Multiple sclerosis
  • Muscular dystrophy
  • Myasthenia Gravis
  • Narcolepsy
  • Obesity and/or a BMI over 40
  • Organ transplant
  • Pacemaker
  • Paralysis
  • Paraplegia
  • Parkinson’s disease
  • Pending surgery or hospitalization
  • Pneumocystic pneumonia
  • Polycythemia Vera
  • Postpartum depression
  • Pregnancy or expectant parent (includes men)
  • Psoriatic arthritis
  • Pulmonary fibrosis
  • Sarcoidosis
  • Scleroderma
  • Seasonal affective disorder
  • Seizures
  • Sex reassignment
  • Sjogren’s syndrome
  • Sleep apnea
  • Stroke
  • Transsexualism
  • Tuberculosis
  • Ulcers (peptic)
  • “Sexual deviation or disorder”

Even the list above isn’t exhaustive. There are hundreds of conditions that an insurer might use during the medical underwriting process, including sub-conditions or very specific definitions of certain conditions, like cancer. The definition of “pre-existing” could include conditions that you’ve had in the past but don’t currently have. If you’ve ever had the following conditions and/or had difficulty due to the following conditions, then you may also be subject to medical underwriting if you let your coverage lapse under the AHCA:

  • Angina
  • Blood forming organ problem
  • CHD
  • COPD
  • Diabetes
  • Depression
  • Drug, alcohol or substance abuse
  • Emphysema
  • Endocrine problem
  • Heart attack
  • Mental retardation
  • Non-skin cancer
  • Schizophrenia, ADD or bipolar disorder
  • Senility
  • Stroke

The American Health Care Act will head to the Senate next for discussion, revision, debate and eventual voting. It’s not clear how much of the original Trumpcare bill will remain intact once senators start working on their own version. The AHCA has been anything but popular among more moderate members of the House and Senate. For people with pre-existing conditions – over a quarter of the country – the new healthcare bill could impact how and if they’re able to get coverage at all on the individual market.


Updated 5/5/2017

Please use the following link for an updated analysis that is reflective of Pre-existing Conditions and how it is impacts the AHCA and or Trumpcare.

Updated Trumpcare Information Regarding Pre-existing Conditions

Updated 11/21/2016

President-Elect Donald Trump’s healthcare reform policy, which is called Trumpcare by consumers and the news media, is presently made up of seven different initiatives or components. The very first point of Trump-care according to his website, is that his healthcare reform proposal requires the Affordable Care Act, or Obamacare as it is also called, to be repealed. He clearly states he would call on Congress to get this done on day one of his presidency.

Although not specifically outlined in his healthcare proposal, President-Elect Trump has stated during his campaign that he does not believe health insurance carriers should be able to refuse coverage to individuals due to pre-existing conditions. This ban on disqualifying a consumer from a health insurance plan due to a medical condition is one of the core components of the Affordable Care Act (Obamacare), which went into effect in 2013. This specific policy is universally the most popular part of the Affordable Care Act with Americans who are both in favor of and against the ACA. Despite its popularity with consumers, this part is considered one of the most costly elements of Obamacare according to health insurance carriers and independent experts in the health insurance industry. Before the Affordable Care Act went into effect in 2013, an individual could be refused coverage for a vast number of pre-existing conditions.

Contrary to what is believed by millions of consumers who had health insurance prior to the launch of the Affordable Care Act, pre-existing conditions were not limited to life-threatening illnesses or conditions, such as HIV/AIDS or cancer. In some cases very common but manageable diseases like diabetes or hepatitis would often prevent individuals from obtaining coverage. Other examples that would result in an individual losing coverage and or being denied coverage were injuries related to workplace accidents or sports injuries that would require a significant surgery and rehabilitation to resolve. It is clear to see why this part of the present law is so popular with Americans.

Donald J. Trump’s Healthcare Reform Policies & Pre-Existing Conditions

As of March 3, 2016, according to the information provided by President-Elect Donald J. Trump’s official website, it is not entirely clear how his proposed healthcare reform would address the issue of pre-existing conditions despite the fact that in publicly televised debates, Donald J. Trumps has stated that individuals should not be excluded from receiving coverage because of a pre-existing condition.

Below are two specific passages from Mr. Trump’s website regarding his position on not allowing individuals with health problems fall through the cracks of the healthcare system. This is the only thing written on Trump’s website presently that we can tie to his position on pre-existing conditions.

From the Opening Statement On His Website:

We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country. By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.

From Point #3 Within His Website:

As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance.

It should be noted that President-Elect Trump’s website makes clear that his policies and what is outlined is simply a starting point. As more information becomes available, we will update this website and each policy section in detail.