Is sexual assualt considered a pre-existing condition in the new US Health Care plan?

Question

I've seen multiple news sites and tweets claiming that the new United States health care plan lists some really odd 'conditions' as valid pre-existing conditions (reasons for an insurer to deny insuring you, or ask for a higher fee). One of these pre-existing conditions that stood out to me is that being a victim of sexual assault is a pre-existing condition. An implicit claim in these tweets is that this did not used to be a pre-existing condition under Obamacare or even before that.

It seems an unnecessarily cruel extension just to save some insurers some extra costs on (much needed) psychological and maybe even physical care. So I'm highly skeptical if its true.

Some sources that list this claim

• Trump's healthcare bill allows rape to be a pre-existing condition (Independent)
• Rape and domestic violence could be pre-existing conditions (CNN)
• 5 Ways the New GOP Health Care Bill Is Even Worse Than Before (Rollingstone)

Answer 1

Tl;dr: the American Health Care Act of 2017 (AHCA) doesn't specifically consider sexual assault a pre-existing condition (PEC), (an unknown amount of) insurance companies consider (the consequences of) sexual assault a PEC. The AHCA only regulates how those companies can treat people with PECs.

---

Reader beware:

This is an emotional and controversial topic. And the answer which will satisfy you will probably come down to semantics (i.e. what does it mean to "allow rape" to be a pre-existing condition? Or what does it mean to "consider sexual assault a pre-existing condition"?).

I'll try to be as comprehensive as I can, but I'll let the reader decide if the answer to this question is a yes or no.

What is a pre-existing condition?

If you read around on the internet, you'll find that there are more than one definition of the term.

One Wikipedia article describes a PEC as such:

The University of Pittsburgh Medical Center defines a pre-existing condition as a "medical condition that occurred before a program of health benefits went into effect"

_{(Emphasize mine)}

Something along these lines is most likely the definition a health care insurance provider would use. However, there are others who use PEC to describe a type of loophole used by insurance companies. To quote the OP:

[PECs are] reasons for an insurer to deny insuring you, or ask for a higher fee.

Or take a look at this article from Politifact: Obamacare to stop domestic violence as pre-existing condition. This is also a good example of people using the term PEC to refer to a "loophole".

To make this answer valid for this site I'll use "the most scientific" definition (IMHO). So from here on out, a PEC is considered a medical condition that occurred before a program of health benefits went into effect.

Obamacare and PECs:

If you have the "correct" definition of a PEC in mind than those articles listed in the question are somewhat misleading. As an example, consider this one snippet from the Independant:

Before Obamacare, some insurance companies considered rape and domestic abuse pre-existing conditions.

They still do. Obamacare only regulated how insurance companies can treat people with a (certain) PEC. As a matter of fact, the Patient Protection Affordable Care Act pretty much says that domestic violence is a PEC:

SEC. 2705. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.

(a) IN GENERAL. — A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility)
of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

...

(7) Evidence of insurability (including conditions arising
out of acts of domestic violence).

_{(Emphasize mine)}

American Health Care Act of 2017 (AHCA) and PECs:

The AHCA follows the same style as Obamacare, i.e. it doesn't contain a comprehensive list of "acceptable" PECs. It does however (de)regulate how insurance companies can treat them.

Politico.com explains the differences between Obamacare and the AHCA:

[The insurance companies] have to provide access to coverage for people with pre-existing conditions. It says nothing about the rates of that coverage.

That means if the AHCA passes, it would allow for people with pre-existing conditions to be charged more per year for their insurance coverage – possibly to the tune of thousands or even tens of thousands of dollars more per year, some studies have found.

_{(emphasize mine)}

So people can not be denied coverage, but theoretically they can be charged extra to the point that some can't afford it.

Conclusion:

Health care insurance companies see a PEC as a medical condition that a person has before or while getting a health insurance. Before Obamacare this meant that they could deny service or charge extra. Obamacare made it harder for insurance companies to do this. The AHCA made it again possible that these companies can charge extra.

Answer 2

No, the AHCA does not contain a list of pre-existing conditions based on which insurers can deny coverage. It does however weaken protections for people with pre-existing conditions, and those conditions may be the result of rape - which is not classified as protected under the AHCA.

You can look at the AHCA yourself, rape is only mentioned in the context of abortion.

AHCA and pre-existing conditions

As your sources mention, the issue is that the AHCA allows states to opt-out of some regulations set by the ACA regarding pre-existing conditions. This is defined in the MacArthur amendment.

Under the ACA, insurers were not allowed to decline people with pre-existing conditions. This is still the case under the AHCA, but insurers can require those people to pay considerably more:

The AHCA does keep the requirement that people with pre-existing conditions must be offered health insurance. But it would drop Obamacare’s rules capping how much extra those people can be charged.

That means if the AHCA passes, it would allow for people with pre-existing conditions to be charged more per year for their insurance coverage – possibly to the tune of thousands or even tens of thousands of dollars more per year, some studies have found. _{source: politifact}

Pre-existing conditions and rape/domestic violence

WFAA fact-checked the claim and states:

We went to the Centers for Medicare and Medicaid Services: a government organization that does list the conditions. While that list does not include rape or sexual assault, it does include several conditions that could result from an attack, like sexually transmitted diseases, PTSD, stress disorders and emotional disturbance.

While we can verify this bill does not define rape as a pre-existing condition, it does define several common side effects as such.

There are also individual cases which show this practice from before the passage of the ACA, such as this case where a rape victim was denied coverage because of HIV meds she took as a precaution after the assault:

Christina Turner feared that she might have been sexually assaulted after two men slipped her a knockout drug. She thought she was taking proper precautions when her doctor prescribed a month's worth of anti-AIDS medicine.

Only later did she learn that she had made herself all but uninsurable.

[...]

Some women have contacted the Investigative Fund to say they were deemed ineligible for health insurance because they had a pre-existing condition as a result of a rape, such as post traumatic stress disorder or a sexually transmitted disease. Other patients and therapists wrote in with allegations that insurers are routinely denying long-term mental health care to women who have been sexually assaulted.

[...]

Holtzman said that health insurance companies also consistently decline coverage for anyone who has taken anti-HIV drugs, even if they test negative for the virus. "It's basically an automatic no," she said.

Some states did have protections for victims of domestic abuse before passage of the ACA, but some did not (see also politifact):

Eight states and the District of Columbia don't have laws that specifically bar insurance companies from using domestic violence as a pre-existing condition to deny health coverage, according to a study from the National Women's Law Center.