“JD Vance Sparks Controversy by Reopening the Heated Debate on Pre-Existing Conditions—What This Means for You!”

In order to cover people with expensive pre-existing conditions, the ACA imposed strict new regulations on insurers that many conservatives have criticized: It required them to offer a minimum suite of “essential benefits” in all plans, it limited how much they could charge based on age (with older adults paying no more than three times as much as younger ones), and it required them to take on all customers regardless of their past or present health status.

In his “Meet The Press” appearance, Vance said Trump would pursue a “deregulatory agenda” around the ACA in order to offer a wider variety of plans and appeared to reference several of these provisions in the interview.

He said that “a young American doesn’t have the same health care needs as a 65-year-old American” and that “a 65-year-old American in good health has much different health care needs than a 65-year-old American with a chronic condition.” This could be taken as a reference to the rules that require insurers to offer customers similar plans, and possibly to the law’s caps on age-related premiums, although because people over 65 are eligible for Medicare it makes the exact point a little unclear.

He also criticized the law for putting people into “the same risk pools” with a “one-size-fits-all approach” — a seeming reference to prior Republican proposals to offer insurance to people with expensive conditions in separate “high-risk pools” rather than require insurers to cover everyone together under similar plans.

The “American Health Care Act” that passed the GOP-led House in 2017 put forward several proposed solutions based on these conservative criticisms, including offering states a waiver that would allow insurers to sell plans that adjusted premiums based on pre-existing conditions in some circumstances and that did not include minimum essential benefits.

A Congressional Budget Office analysis of the bill found that this tiered system of insurance would create a situation for people with expensive conditions in which “premiums would be so high in some areas that the plans would have no enrollment” as younger and healthier people opted for cheaper, health-dependent plans and older and sicker people were funneled toward the pricier, more robust ones.

The bill also included some money to help subsidize the latter group’s coverage, but the CBO concluded it “would not be sufficient to substantially reduce the large increases in premiums for high-cost enrollees.”

“You can’t really say people with pre-existing conditions are protected if they are in a separate insurance risk pool and can be charged exorbitant premiums,” Larry Levitt, executive vice president for health policy at the nonpartisan research group KFF, tweeted after Vance’s interview.

The state waiver provision was later ruled out by the Senate parliamentarian on technical grounds, who concluded it violated procedural rules around legislation passed by reconciliation, and the House bill never became law.

Ultimately, Trump was only able to make changes at the edges of the ACA in Congress, but his administration did pursue a related approach at the executive level by authorizing the sale of insurance plans that could be purchased outside the law’s individual marketplace and not following its rules.