House and Senate Republicans claim their health care bills do not change protections for people with pre-existing conditions. But both the House bill and all iterations of the Senate bill clearly contain provisions that would dramatically reduce protections. While Republican bills continue to provide some financial assistance to consumers, that assistance is significantly lower than it was under the Affordable Care Act (ACA). Lower financial assistance, coupled with fewer consumer protections, would leave individuals facing an insurance market much like they did before the ACA: one with higher costs and fewer protections when people need them most.

The below chart indicates which actions insurers in the individual market are allowed to deploy—in some cases, with state approval—when designing and pricing their plans under the different provisions of the American Health Care Act (House bill) and the Better Health Care Reconciliation Act (Senate bill).

Fewer Protections for People with Pre-Existing Conditions under the House and Senate Health Care Bills than under ACA
Affordable Care Act House Bill: MacArthur / Upton Amendments Senate Bill: State Innovation Waiver Changes Senate Bill: Small Business Health Plans Senate Bill: Cruz Amendment
Actor Federal government States States Insurers Insurers
Allowed Actions
Denial of coverage X X
Higher premiums based on health and medical history X (for people with coverage breaks) X X
Fewer benefits X X X X
Higher cost sharing X X X
Annual / lifetime limits X X X X
Preventive services coverage X