WASHINGTON — President Trump and Republicans in Congress say they are committed to protecting people with pre-existing medical conditions. But patients with cancer, diabetes and H.I.V., for example, would have significantly less protection under Republican proposals than under the Affordable Care Act.
The proposals may provide some political cover for Republicans on an issue likely to figure prominently in the 2020 elections. But a close inspection of the Republican bills shows that their protections are undercut by a combination of imprecise language, explicit exceptions and “rules of construction” that explain how the legislation is to be interpreted.
“We will always be protecting pre-existing conditions,” Mr. Trump said this past week in a visit to Minnesota, echoing a vow he has made at least 20 times in the past six months. “Remember that. That’s No. 1. Very, very important.”
A recent bill, introduced by Senator Thom Tillis, Republican of North Carolina, and endorsed by 22 other Republican senators, would prohibit insurance companies from denying coverage because of a person’s pre-existing conditions.
Mr. Tillis, who is up for re-election next year, said he also wanted to “prohibit insurance companies from charging you higher premiums due to pre-existing conditions.” Whether the language of the bill would actually achieve that result is unclear.
Representative Greg Walden, Republican of Oregon, has introduced a similar bill, the Pre-Existing Conditions Protection Act, and he said his commitment was informed by experience: He had a son who was born with a heart defect 25 years ago and died a day later.
The Republican proposals would provide some protections for people with pre-existing conditions. But they are not as comprehensive as the protections in the Affordable Care Act, which result from several interrelated provisions.
The bills do not specify what benefits must be provided. They do not prohibit insurers from charging women more than men, as insurers often did before the Affordable Care Act. And they would not ban annual or lifetime limits on benefits. Such limits are of most concern to people with serious illnesses.
Under the Republican proposals, an insurer offering coverage to a group or an individual must — with certain limited exceptions — accept every employer and individual in the state who applies during an enrollment period.
The Senate and House bills both have provisions “prohibiting discrimination” in eligibility and premiums based on a person’s health status.
But other provisions of the two bills “could be read as undermining those protections against discriminatory premiums,” said Edward G. Grossman, who drafted health care bills for Republicans and Democrats as a lawyer for more than 40 years in the House Office of the Legislative Counsel.
Thus, for example, the Republican bills say that an insurer cannot charge one person more than another “on the basis of any health status-related factor.”
But the bills then appear to qualify this guarantee, saying that it shall not be construed to restrict the amount that an employer or an individual may be charged for coverage. Republicans said their purpose here was to make clear that the federal government could not tell health insurance plans what to charge.
The American Heart Association and 32 other patient groups expressed concern about an earlier version of the Senate bill. The proposed safeguards “fall far short of the patient protections” provided under current law, they said in a letter to Senate leaders.
The Affordable Care Act, President Barack Obama’s proudest legislative achievement, forbids insurers to deny coverage or charge higher prices because of a person’s medical condition or history.
Other provisions of the law prohibit insurers from charging women more than men because of their sex, limit out-of-pocket costs for consumers, and prevent insurers from setting annual or lifetime limits on what they spend on the benefits they are required to provide.
The Affordable Care Act also requires insurers to provide certain “essential health benefits,” including maternity care, prescription drugs, mental health care and drug abuse treatment.
The protections for people with pre-existing conditions are among the most popular provisions of the 2010 health law. Democrats rode the issue to victory in many House races last fall, and they give every indication that they intend to emphasize it again in 2020.
“Republicans are terrified that Democrats will use the issue of pre-existing conditions as a cudgel to beat up Republicans,” said Michael F. Cannon, the director of health policy studies at the libertarian Cato Institute. “That’s what they did in 2018, and it worked.”
Health care dominated television commercials run by Democratic candidates for Congress in the fall. They argued that Republicans, in trying to repeal the Affordable Care Act, had repeatedly voted to take away the protections for people with pre-existing conditions.
The political risks for Republican lawmakers increased in December after a federal judge in Texas invalidated the entire health law, including the protections for pre-existing conditions. The Trump administration said it would not defend the law in court, but would instead support the judge’s ruling on appeal.
Representative Kevin Brady of Texas, the senior Republican on the Ways and Means Committee, promised that “Republicans won’t let the courts take away pre-existing condition protections.” And “if the court strikes down the Affordable Care Act,” he said, “Republicans will act to protect those with pre-existing conditions.”
Democrats distrust those assurances.
“The Republican bill does not include critical A.C.A. consumer protections, including community rating, essential health benefits requirements and annual or lifetime prohibitions,” said Representative Frank Pallone Jr., Democrat of New Jersey and the chairman of the Energy and Commerce Committee.
Under the bill, Mr. Pallone said, “you could theoretically buy insurance if you have a pre-existing condition, but it is very deceptive because the bill will still allow insurers to set premiums based on health status.”
Republicans say that is not their intent.
Representative Jim McGovern, Democrat of Massachusetts, said the Republicans were being hypocritical, or at least inconsistent. When Republicans were in the majority, Mr. McGovern said, they pushed legislation that would have “ripped protections away from people with pre-existing conditions,” but now they trumpet their support for those protections.
Sarah Lueck, a health policy analyst at the liberal-leaning Center on Budget and Policy Priorities, saw another potential problem in the Senate bill. Even if a person with cancer could buy insurance without being charged a higher premium, she said, “his or her benefits could run out because the insurer imposes an annual or lifetime limit.”
Republicans say they want to work with Democrats on the issue.
Representative Tom Reed of New York, for example, said that Democrats should just “take yes for an answer” because Republicans agree with them on the need to protect people with pre-existing conditions.
“We heard the voice and the fear that was the result of the 2018 election, where this issue became a centerpiece in that vernacular and in that debate,” Mr. Reed said. “Pre-existing condition protections will remain the law of the land.”B:
“【不】【过】【这】【并】【不】【意】【外】，【记】【忆】【中】，【温】【妮】【曾】【经】【帮】【助】【管】【理】【过】【家】【族】【的】【企】【业】，【有】【相】【关】【的】【经】【验】。”**【忽】【然】【想】【到】。 “【拉】【德】，【还】【住】【在】【隔】【壁】【吗】？”**【问】【温】【妮】【道】，【他】【需】【要】【拉】【德】【帮】【助】【他】【为】【派】【克】【买】【一】【张】【列】【车】【票】。 【温】【妮】【回】【答】【道】“【还】【在】【隔】【壁】。” “【不】【错】”**【扭】【脸】【就】【走】【向】【了】【拉】【德】【的】【房】【间】【里】。 【时】【间】【已】【经】【到】【傍】【晚】，【房】【间】【内】【已】【经】【有】【些】【昏】【暗】，
【铁】【列】【克】【提】【之】【战】（【中】【篇】【小】【说】）【张】【宝】【同】 【故】【事】【讲】【到】【这】【里】，【已】【是】【晚】【间】【八】【点】【来】【钟】【了】。【我】【对】【他】【说】，【让】【你】【一】【下】【子】【讲】【了】【这】【长】【时】【间】，【也】【饿】【了】【吧】，【走】，【我】【们】【出】【去】【吃】【个】【饭】。【他】【说】，【中】。【于】【是】，【我】【就】【开】【车】【把】【他】【带】【到】【了】【毛】【家】【湘】【菜】【馆】。【这】【是】【我】【们】【长】【沙】【比】【较】【出】【名】【的】【一】【家】【餐】【馆】，【烧】【的】【是】【正】【宗】【的】***【家】【乡】【韶】【山】【的】【土】【菜】。 【一】【进】【到】【餐】【馆】，【有】【一】【座】【一】【米】【来】【高】
【贾】【琮】【的】【面】【上】【看】【不】【出】【任】【何】【表】【情】，【不】【论】【是】【胜】【券】【在】【握】【还】【是】【胆】【怯】【担】【忧】【都】【瞧】【不】【出】【来】，【他】【也】【和】【这】【些】【便】【服】【的】【人】【一】【般】，【低】【调】【地】【只】【套】【了】【粗】【布】【麻】【衣】，【认】【出】【他】【的】【南】【城】【及】【路】【过】【百】【姓】【商】【贾】【也】【绝】【对】【说】【不】【上】【多】【数】【的】，【因】【为】【状】【元】【夸】【街】【骑】【马】【已】【是】【五】【年】【前】【的】【事】【了】，【他】【平】【静】【地】【道】：“【可】【以】，【承】【蒙】【王】【院】【使】【看】【得】【起】，**【为】【先】，【还】【是】【你】【们】【的】【人】【先】【来】【吧】。” 【但】【是】【破】【庙】【内】今晚输尽光【崔】【沣】【醒】【来】【时】【发】【现】【自】【己】【已】【经】【躺】【在】【一】【个】【陌】【生】【而】【豪】【华】【的】【地】【方】。 【她】【感】【觉】【自】【己】【身】【体】【无】【比】【轻】【松】，【那】【种】【烈】【火】【灼】【心】【的】【痛】【苦】【消】【失】【的】【无】【影】【无】【踪】。【然】【而】【与】【之】【对】【应】【的】【是】【她】【的】【头】【脑】，【昏】【昏】【沉】【沉】，【有】【些】【不】【知】【今】【夕】【何】【夕】。 “【公】【主】，【您】【醒】【了】？”【这】【时】【一】【道】【端】【庄】【中】【透】【着】【喜】【悦】【的】【声】【音】【传】【来】。 【崔】【沣】【强】【撑】【起】【身】【体】，【一】【双】【手】【及】【时】【地】【扶】【住】【了】【她】，【给】【她】【垫】【了】【个】【靠】
【华】【美】【的】【盖】【头】【盖】【上】，【墨】【凤】【舞】【随】【即】【被】【小】【心】【轻】【扶】【着】【走】【出】【房】【门】。 【一】【时】【间】，【整】【个】【墨】【府】【上】【下】【鼓】【乐】【齐】【鸣】，【欢】【声】【雷】【动】，【甚】【至】【连】【外】【面】【的】【街】【道】【上】，【都】【传】【来】【百】【姓】【们】【兴】【奋】【的】【欢】【呼】【声】。 【而】【与】【此】【同】【时】，【就】【在】【墨】【凤】【舞】【离】【开】【院】【子】【没】【多】【久】，【一】【个】【人】【影】【却】【忽】【然】【来】【到】【房】【间】【门】【口】。 【此】【人】【看】【似】【随】【意】，【但】【目】【光】【却】【四】【下】【飞】【快】【移】【动】，【确】【定】【四】【周】【无】【人】【后】，【便】【猛】【然】【一】【个】
“【谁】……【谁】【要】【想】【你】！【你】【少】【自】【作】【多】【情】【了】！”【关】【秋】【秋】【的】【脸】【顿】【时】【红】【了】，【语】【无】【伦】【次】【地】【睨】【了】【他】【一】【眼】。 【司】【北】【丞】【眯】【起】【眼】，【身】【子】【朝】【她】【倾】【斜】【过】【去】：“【关】【秋】【秋】，【你】【这】【是】【在】【挑】【战】【我】【的】【忍】【耐】【性】【吗】？【嗯】？” “【咳】……”【感】【受】【到】【一】【股】【强】【大】【的】【压】【迫】【力】，【关】【秋】【秋】【赶】【紧】【轻】【咳】【一】【声】，【试】【图】【缓】【解】【尴】【尬】。 “【看】【来】【是】【我】【这】【个】【做】【老】【公】【的】【太】【放】【任】【你】【了】。”【司】【北】【丞】