FACT CHECK: Does Obamacare Allow States To Waive Protections For Pre-Existing Conditions?

David Sivak | Fact Check Editor

Former Republican Senator Rick Santorum, who helped author the Graham-Cassidy health care bill, claimed Tuesday that Obamacare allows states to opt out of coverage protections for people with pre-existing conditions.

“Under both laws, the states can get a waiver on the – on the issue of pre-existing conditions,” claimed Santorum on CNN.

Verdict: False

While states can receive waivers for many provisions of Obamacare they cannot opt out of coverage protections for people with pre-existing conditions.

Fact Check:

Starting this year, Obamacare allows the Department of Health and Human Services (HHS) and the Treasury Department to waive major elements of the health care law on a state by state basis. Among other provisions, states can seek waivers for the individual and employer mandates, requirements for essential health benefits and rules concerning federal tax credits, cost sharing and risk pools.

But the federal government cannot waive rules that protect consumers with pre-existing conditions, as Santorum claimed.

The waiver doesn’t allow states to opt out of the Medicaid expansion, or several other major provisions of Obamacare either. For example, states must continue to allow dependents up to the age of 26 to stay on a parent’s health insurance plan.

Waivers are meant to encourage states to enact health care reforms without compromising the core aims of Obamacare. As a result, HHS will only grant waivers if a state can demonstrate that its residents would have coverage that’s at least as “comprehensive and affordable” and would provide insurance to a “comparable number of residents.”

A state must also pass a law with the desired reforms before it can apply for a waiver. If a state can meet the requirements, the federal government may provide payments equal to the federal funding they would have received without the waiver.

Several states have already submitted proposals for waivers, but only two statesAlaska and Hawaii – have received approval. In March, HHS Secretary Tom Price sent a letter encouraging states to take advantage of the waivers.

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David Sivak

Fact Check Editor
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