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Study: Cruz amendment could raise premiums for 1.5M with pre-existing conditions

One and a half million people with pre-existing conditions could face higher premiums under an amendment to the Senate’s healthcare bill being pushed by Sen. Ted Cruz (R-Texas), according to a new analysis released Tuesday. 

The proposed amendment, which is being considered by GOP leadership, would essentially let insurers sell plans that don’t meet Affordable Care Act (ACA) requirements as long as they also sell plans that do.

Cruz says giving insurers a path around the regulations should allow them to offer some plans at a lower cost. 


An analysis from the Kaiser Family Foundation says that premiums for those ObamaCare-compliant plans would “skyrocket,” impacting about 1.5 million people with pre-existing conditions who will also become ineligible for subsidies under the bill. 

“The ACA-compliant plans would effectively become a high-risk pool, attracting enrollees when they need costly health benefits — such as maternity care, or drugs to treat cancer or HIV, or therapies to treat mental health and substance abuse disorders — and those with pre-existing conditions who are turned down by non-compliant plans or charged high premiums based on their health,” the authors wrote. 

Increases would mostly effect people who don’t get subsidies, which are designed to increase with premiums. 

But the Senate bill also scales back eligibility for tax credits to 350 percent of the federal poverty level, compared to 400 percent under ObamaCare. That means an individual with an annual income of $41,580 or higher would not be eligible for the tax credits. Under ObamaCare, the cutoff is $47,550.

Of those in the market with incomes of at least 350 percent of the poverty line, 24 percent, or about 1.5 million, have pre-existing conditions, according to Kaiser. 

Kaiser also notes that premiums for the plans that don’t comply with ObamaCare regulations would be “substantially lower” while covering fewer benefits. 

Republican leaders on Tuesday outlined a revised version of the bill, which is aimed at winning over additional support after the legislation was pulled before a vote last month. 

It’s unclear if the Cruz amendment will be in the bill that leader’s expect to vote on next week. 

Senators will receive two drafts of the bill Thursday: one with the Cruz amendment and one without. 

Leaders say they’re still waiting for an analysis of the amendment from the Congressional Budget Office to make a decision.

Tags Ted Cruz

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