People protest Trump administration policies that threaten the Affordable Care Act, Medicare and Medicaid on Jan. 25 in Los Angeles. | Getty Fears over pre-existing conditions haunt Obamacare debate Republicans would attach strings to their version of a rule banning insurers from charging sick people more.

Republican lawmakers will resume work on an Obamacare replacement plan this week after facing anxious hometown crowds who fear losing guaranteed coverage for people with pre-existing conditions.

GOP lawmakers have vowed their replacement plan will keep the requirement that insurers accept everyone regardless of potentially costly medical conditions. But the Republican proposals would be different than Obamacare in a key respect: They would allow insurers to charge more to sick people who had been uninsured right before trying to enroll in a new plan.


Though details haven't been finalized, all of the GOP proposals being discussed follow the same blueprint: Health plans can't turn away sick customers or charge them more, as long as the insured person maintained continuous coverage for a period before enrolling in a new plan. Those who dropped coverage because it was too expensive could be charged more or face other discrimination.

A bill by Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine) would deny protections to people who have gone uninsured longer than 63 days unless they enroll in a high-deductible health plan, where they couldn’t be charged more than others because of their medical history. The House’s "Better Way" agenda, as well as a plan from Sen. Rand Paul (R-Ky.), embrace the continuous coverage policies as well.

Skeptics say the GOP's version won't really help sick people, especially if there aren't accompanying safeguards to ensure that insurance is affordable.

“That provision is cruel and inhumane and doesn’t solve anyone’s problems,” said Sen. Chris Murphy (D-Conn.). “If their plan doesn’t allow for people to afford health care, you can virtually guarantee when people get sick they’ll have a gap in coverage. It’s not protection at all.”

Concern over the future of the wildly popular Obamacare provision catalyzed town hall meetings during the Presidents Day recess.

Iowan Joy Newcom implored Sen. Chuck Grassley at one gathering last Tuesday to help preserve the pre-existing conditions protections. It was at least the third time Grassley heard the appeal that day, and he tried to assure Newcom and others gathered in Garner, Iowa, that the requirement will likely be part of any Republican alternative to the Affordable Care Act.

“There are a lot of consensus in Washington that the one issue that you brought up — pre-existing conditions — should not be changed,” the seven-term Republican told the packed town hall meeting.

Rep. Marsha Blackburn (R-Tenn.) made a similar pledge at a town hall last week.

“Those with pre-existing conditions are still going to have coverage,” Blackburn said in Fairview, Tenn., on Tuesday. “Our goal is that health care is going to be more flexible, more usable and more affordable to everyone.”

Gary Claxton, an insurance expert at the Kaiser Family Foundation, says the GOP policy could end up placing some consumers in an insurance “purgatory” if they face sudden hardship and can’t afford to keep paying premiums.

“There is a question if, when you’re going through a problem, how easy is it to miss one or two months of insurance or not keep your job-based coverage,” he said. “And then it’s really hard to get back in when you’re out.”

To be sure, there have been problems stemming from the Obamacare requirement. Under the ACA, insurers had to accept everyone, regardless of when they last had insurance.

The insurers' risk was supposed to be offset by the law's individual mandate requiring most Americans to buy coverage. The theory was that an ironclad coverage rule would dissuade people from gaming the system by jumping in and out of coverage.

But things didn't go as planned, to hear the insurance companies tell it. There were too many loopholes in the law, such as spotty enforcement of the mandate and not enough oversight of the special enrollment periods that allowed people to sign up for insurance any time of year.

Insurers have related anecdotes of people only buying insurance when facing pricey medical procedures — such as a knee replacement — and then dropping coverage when their treatment was over. That left health insurers paying for several expensive months of care, with no corresponding period when the covered person was healthy to balance out the cost.

A continuous coverage requirement, as the GOP calls it, would discourage people from dropping in and out according to their needs. Similar penalties are in place if people sign up late for Medicare Part D outpatient drug coverage.

Newcom told Grassley on Tuesday that she worries about losing protection as lawmakers work through repeal-replace — a sentiment repeated at the senator’s two other town hall meetings in the Hawkeye State.

“You cannot say repeal and then fix. You can’t have even a breath of daylight — not even a breath of daylight,” Newcom said. “Every single one of us walks around as a pre-existing condition.”

Paul Demko and Kyle Cheney contributed to this report.