In the new version of the American Health Care Act (AHCA), the Republican bill to

replace the Obama-era Affordable Care Act (ACA), one of the major points dividing
the GOP conference was the treatment of pre-existing conditions.

The guarantee of health care coverage to people with pre-existing conditions has
been one of the ACA's most popular features. Under the law, insurance companies
cannot refuse to cover those with pre-existing conditions, that is, health issues that
pre-date a new health insurance coverage. Insurers also can't charge more or refuse
to pay for Obamacare "essential benefits" for any pre-existing condition. And, once
enrolled in a plan, insurers can't deny such patients coverage or raise rates based
solely on their health.

The new GOP plan requires insurers to cover pre-existing conditions, and for those
with continuous health care coverage, nothing will change. There are some caveats,
though.

Insurers would be able to charge more to people with gaps in their insurance
coverage. And a recent change, the MacArthur amendment, would allow states to
waive some of the Obamacare requirements, including one that's relevant to pre-
existing conditions. States that are granted such a waiver would allow insurers to
set premiums based on health status -- current health, health history and other risk
factors -- or in other words, pre-existing conditions.

These states would also be able to set up high-risk pools to help reimburse the cost
for insurers covering these consumers. The AHCA would provide funding for this
purpose, though critics suggest it may not be enough.

States are likely to leave it to insurers to define pre-existing conditions, but prior to
the ACA, pregnancy fell into that category, as well as mental disorders, and alcohol
or drug abuse. The Kaiser Family Foundation compiled a list of what insurers called
"declinable medical conditions" and risk factors that, prior to the ACA, could mean
denial of coverage or higher premiums. Here are some of the conditions identified
by individual market insurers in most states:

Alzheimers or dementia
Alcohol or drug abuse

Arthritis, fibromyalgia, or other inflammatory joint disease

Cancer within a period of time (the example cited by KFF is 10 years, "often other
than basal skin cancer")

Cerebral palsy

Congestive heart failure

Diabetes mellitus

Emphysema

Epilepsy

Heart disease

Hepatitis

Kidney disease

Mental disorders - bipolar, or eating disorders, e.g.

Multiple

Sclerosis

Muscular dystrophy

Obesity (severe)

Organ transplant

Paraplegia

Paralysis

Parkinson's disease

Pending surgery or hospitalization

Pneumocystic pneumonia

Pregnancy or expectant parent

Sleep apnea

Stroke

Transsexualism
Jennifer Tolbert, who is the Director of State Health Reform at the Kaiser Family
Foundation, has read the AHCA and says at this point, it's not entirely clear how
consumers with these conditions will be affected.

She said that in the past, individuals with pre-existing conditions in high-risk pools
typically paid more than the average premium, "maybe 1.5 times as much," she
said. But Tolbert also pointed out other problems, such as that pre-ACA, consumers
faced waiting lists to get into high-risk pools or higher deductibles or insurance that
didn't cover the medical problems stemming from the pre-existing condition.

She also pointed to another factor to consider, related to insurance coverage for
people with pre-existing conditions: the AHCA would change the structure of the
premium tax credits in the marketplaces, so older Americans, who are likely to be
sicker, will probably see their tax credits go down.

This, combined with the rise in age rating (allowing seniors to be charged up to five
times as much for coverage as younger Americans, rather than three times as much
under the ACA) and the phase-out of the Medicaid expansion, is likely to result in
more Americans losing their insurance coverage, according to Tolbert.