GOP Health Bill Would Let States Determine 'Pre-Existing Condition' Protections : Shots - Health News Before the Affordable Care Act, people with pre-existing conditions often couldn't get health insurance — or paid sky-high premiums. The bill passed by the House last week would let states decide.

GOP Health Bill Leaves Many 'Pre-Existing Condition' Protections Up To States

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Right now under the Affordable Care Act, people with pre-existing conditions have a lot of protections. But the House bill passed last week leaves a lot of those provisions up to state politics. Bram Sable-Smith of member station KBIA in Missouri reports.

BRAM SABLE-SMITH, BYLINE: Ryan Lennon Fines seems like a typical 2-year-old.


SCOTT FINES: What is that?

RYAN: Fire truck.

FINES: That's right.

SABLE-SMITH: He and his parents, Scott Fines and Brianna Lennon, flip through a picture book of emergency vehicles. They land on a photo of an airplane.

FINES: Hey, there's an air ambulance. You rode in that. You rode in one of those.

SABLE-SMITH: When Ryan was born in 2014, his mouth was not connected to his stomach. After three months in a hospital in St. Louis, the family flew to Boston where Ryan had surgery.

FINES: And we were there from the 17th until just before Memorial Day that year.

BRIANNA LENNON: We're coming up on his discharge anniversary.

FINES: That's right (unintelligible).

LENNON: It's May 12.

SABLE-SMITH: The surgery worked. Ryan's active. He can eat normally, and he eats a ton. But all that time in the hospital and the surgery were expensive.

FINES: Our insurance was billed about $750,000. And it was 2014, so the ACA was in place, and we didn't end up having to pay $750,000, which was very nice.

SABLE-SMITH: Now the family is worried about Ryan's future. He'll still need about $20,000 to $30,000 of medical care every year. And even though they have insurance through Scott's work, the bill that passed the House last week could really affect them.

All six Republicans from Missouri voted for the bill, including Representative Vicky Hartzler from the district where Scott, Brianna and Ryan live. In a video posted to Twitter, she said passing the bill was an important first step to replacing Obamacare.


VICKY HARTZLER: It covers pre-existing conditions, still retains the ability for young people to stay on their parents' policies, and it makes sure that there are no lifetime caps.

SABLE-SMITH: But the bill gives states license to make a lot of changes. It does keep the provision that people like Ryan with pre-existing conditions cannot be denied coverage, but a last-minute amendment allows states to ask permission for insurers to charge more based on a patient's health history if their coverage ever lapses. This tremendously weakens the current protections, says Larry Levitt with the Kaiser Family Foundation.

LARRY LEVITT: This would guarantee access to insurance for people with pre-existing conditions in theory but not really in practice because they could be charged astronomically high premiums.

SABLE-SMITH: What's more, right now under Obamacare, there are limits to the amount someone would have to pay out of pocket any year, and there are no lifetime limits on benefits. Language in the bill may end up weakening those protections also.

Missouri's governor, Eric Greitens, supported the GOP health plan in March. His office didn't respond to questions about whether he'd want Missouri to opt out, but Larry Levitt says it's likely conservative states that might want to.

LEVITT: States that have not expanded Medicaid made a decision to not go along with the Affordable Care Act where they can, and you'd probably see those states facing a similar kind of decision here.

SABLE-SMITH: Scott, Brianna and Ryan face tough decisions if this bill becomes law.

Would you all consider moving?

FINES: I think we'd pretty much have to. We would have to either move to a state that didn't waive community protections or out of the country entirely. I'm not going to risk my son's health on the political whims of Jefferson City.

SABLE-SMITH: But before any decisions are made in Missouri's state capitol, the bill moves on to the U.S. Senate where it could change. For NPR News, I'm Bram Sable-Smith in Missouri.

SIEGEL: And that story is part of a reporting partnership of NPR, Side Effects Public Media and Kaiser Health News.

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