Some Facts About Pre-Existing Conditions And The AHCA


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We are the pain community of the United States of America. How are we to know who to believe or what is the truth? Nothing feels transparent anymore, or has it ever been? I am writing this as a non partisan Chronic pain patient. I don’t know what to think anymore or who to believe. I remember President Obama standing right there inside of my Television set, telling me, looking me in the eyes and stating “If you like your Dr., you can keep your Dr.”! He told us that we could choose our physicians, hospitals and that things would not change much, but only get better. But then our premiums and co-pays tripled in amount.  We went from a zero deductible on our health insurance plan to a $1200.00 per person in the family, per year! My husbands paycheck went down to what it had been 7 years ago and the paychecks continued getting smaller. Every test and everything that I have to get done, medically must be paid “up front” for the first $1200.00.  Then they will pay maybe 80%? Our co-pays for medications went from $5 to $40 for each of my several medications and office visits went from $10 to $30 per visit.  Living with too many high chronic pain illnesses to name,  this is really hurting my family.

Don’t get upset with me yet, I’m not putting down anyone, nor am I supporting them. I’m just trying to get the facts out of my head and onto this page.  I want others to know more about both, so they can possibly feel informed.  We all know that  if we read or turn on the TV, to become more knowledgeable about this, sometimes we cannot see the truth from an untruth. It all seems to depend on which channel you watch or what newspaper you read.

With Obamacare we were promised that health premiums would decline by $2,500 per family. But the average premium has gone up and the average family’s employer-sponsored health care plan now costs more than $18,000 a year.  My husband and I have an employer-sponsored health care plan and it has tripled as I mentioned above. Last year in 2016, we saw an increase on the Obamacare policies and in 2017, at least in Michigan and for individuals; the premiums are supposed to go up almost 17%!  The UAW is happy because in 2018, all of their employee provided health care was going to be counted as income and TAXED! It is called the “Cadillac TAX” and it was going to have the middle class working families fund subsidies for poor people. This is crazy! How can people live day to day when they are ill at all? Do they really just wish us “away”?  Physicians are quitting in large numbers and pain Dr.’s are leaving in droves.

Now President Trump comes in and says that he is going to “fix things” for us. But I don’t  know what to believe about this new healthcare bill. We won’t until we read the final Senate approved version.  Below I have described for you a few of the changes that appear to be an improvement over Obamacare:

  • This new Health care Act will eliminate the individual and employer based , “FINE”, or “PENALTY”; which is money that someone has to pay if they don’t wish to purchase Obamacare or have insurance at all.
  • The new Health care Act would help decrease or take away the Obamacare taxes that have increased the premium costs, and limited options for patients and physicians.
  • Everything that I have read about this new Health Care Act, states that  persons with “PRE-EXISTING CONDITIONS” are guaranteed coverage. It also bans health insurance companies from raising premiums for people with pre-existing conditions also.  The catch is this:  You must maintain insurance coverage or sign up for new insurance within 63 days of leaving your current plan. I also read that they are putting 8 billion dollars in a special fund for states to help people with pre-existing conditions.  That is so all of the healthy people don’t have to pay for us unhealthy people.
  • This plan is allowing parents to keep their young adult children or dependents covered until they are 26 years old.  This is a part of Obamacare that I’m pretty sure everyone likes.
  • This plan is supposed to help Americans access affordable quality health care by giving us a tax credit. I read that this credit would be between $2,000 and $14,000 per year for low and middle income families and individuals who DON’T RECEIVE insurance through an employer or a government program

There is a “Public Health Service Act” in legislation that is requiring members of congress to also partake in this American Health Care Act.  So they are saying that there will be “no exemptions” and everyone will be getting the same plan(s). This means that the government employees will have to have the same coverage as the people.

It is very regrettable that so much misinformation is being spread about this bill. I especially feared for the “pre-existing conditions” part of this Health care Act.  All I heard from everyone was that these were going to be excluded and people like me, with many health challenges; would not be covered. But from all that I’ve researched and read for myself, this is the truth:  Under no circumstances can people be denied coverage due to a pre-existing condition!  The laws that we have now will still be in place and can only be changed if a state chooses to take care of us in another way.   No state can take away our coverage based on a “Pre-existing condition”, regardless if they get a “waiver” or not.  From what I’ve read, nobody can be priced based on their health status as long as they’ve maintained continuous coverage of their health insurance.

On November 8th, 2016, by the rules of our American constitution and by the votes of the American people, Change happened! Whether we like it or we don’t, it is happening right now.  One thing we don’t want is for the government to take over our health care.  We need to be allowed choices and to have the freedom to choose our health care.

To reiterate some things that I’ve stated, I understand that members of Congress will have to have the same AHCA as the people of the USA with no exemptions. I also now know that people with pre-existing conditions will not be charged higher premiums, nor will they be excluded from health care coverage. There are special funds for states who choose to opt out of certain programs, it appears.  But still they are saying that nobody with pre-existing conditions will be hurt in this plan. There is something called the “MacArthur amendment”.  This amendment allows the insurance companies to charge higher premiums for a person with a health condition ONLY IF THEY DO NOT MAINTAIN CONTINUOUS COVERAGE. It also only applies to the “individual insurance market”, which really only applies to 7% of the country.  So you see, this does NOT  apply to 93% of the persons with employer-provided coverage or government coverage, such as: Medicare, Medicaid, Tricare, VA benefits and others. One last piece of information is that the higher premiums included in that 7%, can only be charge for ONE YEAR and only to people who did not maintain continuous coverage.  Lastly, the 8 billion dollars for the special state programs will be ON TOP OF $130 billion. This will be available to states through the American Health care plans’ patient and state stability fund.   The states can use these funds to help lower the out of pocket costs, like premiums and deductibles. They may use the money also to help maintain preventative services (annual health check ups), dental and vision care.

Lastly, regarding the AHCA, there will be a refundable tax credit to persons without other health care options so they can get covered and stay that way BEFORE something medically catastrophic happens to them. All of these ideas stated in this post seem to prove to me that people with pre-existing conditions will be covered. But we really won’t know anything until the final version of the AHCA is passed. We can only pray that both parties will try harder to work together and stop so much “HATE” for the other side, whichever side that may be.  The Government needs to work together for something that will be a combination of what the Democrats want and need to work for their constituants and what the Republicans want and need for theirs as well.  We all are ONE COUNTRY and it is turning ugly. I don’t like it one bit. I don’t want to be for or against anyone or anything until I know  the whole truth. I don’t want anyone to be hurt. I certainly don’t want anyone that I love or me, to lose health coverage.  Mostly everyone I love has a pre-existing condition! So let’s just wait a bit, until we have all of the facts.  I’m not for or against either party, I’m just trying to get some information out there for all of the people.

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