Navigating Pre-Existing Conditions

Under the ACA:

Proposed under the AHCA:


Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.

Source: hhs.gov

  • Impose new insurance market regulations including prohibiting pre-existing condition exclusion periods
  • Individual health insurance market rules – Prohibit pre-existing condition exclusions
  • High risk pools – Create a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions 2010-2013.

Source: kff.org


The American Health Care Act stipulates that states can allow insurers to charge people with pre-existing conditions more for health insurance if the states meet certain conditions, such as setting up high-risk insurance pools. Insurers still cannot deny people coverage outright, as was a common practice before the ACA’s passage, but they can hike up premiums to an unaffordable amount, effectively pricing people out of the market.

Source: time.com

  • Retain private market rules including prohibition on pre-existing condition exclusions
  • Individual Health Insurance Market Rules – Prohibition on pre-existing condition exclusion periods is not changed. Short term non-renewable policies can continue to exclude pre-existing conditions
  • Women’s Health – Prohibition on pre-existing conditions exclusions, including for pregnancy, prior Csection, and history of domestic violence, is not changed.
  • State’s Role – State waiver applications would be deemed approved within 60 days of submission unless the Secretary denies the application. Applications must specify how the waiver would achieve at least one of the following goals: reduce average health insurance premiums, increase health coverage enrollment, stabilize the health insurance market, stabilize premiums for people with pre-existing conditions, or increase choice of health plans.

Source: kff.org