A provision of the new Trumpcare bill gaining steam among Senate Republicans — a bill commonly referred to as “Graham-Cassidy” after its two leading proponents — would allow many insurers to drive up premiums the minute someone gets sick.

This provision allows states to obtain waivers from the Affordable Care Act’s requirement that no one can be charged a higher premium because of a “health status-related factor,” effectively allowing insurers to discriminate against people with pre-existing health conditions.

But that’s not all. The new Trumpcare bill wouldn’t simply allow insurers to discriminate against people whose health condition manifested before they signed up for insurance. Graham-Cassidy also potentially permits insurers to charge higher premiums “as a condition of enrollment or continued enrollment.”

Thus, a person who is already insured could be forced to pay much higher premiums as a condition of their “continued enrollment” in that health plan after they are diagnosed with a new health condition.


A new paper by the Center for American Progress’ Sam Berger and Emily Gee examines just how much insurers are likely to jack up premiums for various conditions. (Disclosure: ThinkProgress is an editorially independent site housed at the Center for American Progress.) According to Berger and Gee’s analysis, the numbers are grim.

A 40-year-old diagnosed with metastatic cancer, for example, could expect to pay a $140,510 surcharge on their annual health premium, effectively making many families choose between being bankrupted by their insurance company or being bankrupted by their hospital bills. Meanwhile, someone with a more routine condition such as asthma or diabetes would see their premiums more than double in states that obtain a waiver under Graham-Cassidy.

Berger and Gee derived these numbers by examining how much money the Centers for Medicare and Medicaid Services transfers between insurers under its risk adjustment program, which encourages insurers to enroll high-risk patients by subsidizing insurers that take on high numbers of people with expensive conditions and effectively taxing insurers that take on low-risk patients.

The last time a Trumpcare bill was before the Senate, it was effectively killed by Republican Sens. Susan Collins (R-ME), Lisa Murkowski (R-AK), and John McCain (R-AZ). This time around, Trumpcare opponents are hoping to hold onto these votes, at least one of which is uncertain, while potentially picking up other Republican senators such as Shelley Moore Capito (R-WV), Rob Portman (R-OH), Lamar Alexander (R-TN), and Cory Gardner (R-CO).