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Trump guarantees protection for those with preexisting medical conditions — but it’s unclear how

Will the GOP health care bill cover people with preexisting conditions? (Video: Peter Stevenson/The Washington Post)

President Trump tried Sunday to reassure anxious Republicans that the latest proposal to replace the Affordable Care Act would continue to protect those with preexisting medical conditions, although he struggled to fully articulate what form those protections would take.

As Republicans have tried to find a health-care bill on which they can reach a consensus, Speaker Paul D. Ryan (R-Wis.) agreed to support an amendment that would allow insurance providers in some states to deny coverage or charge higher premiums to people with preexisting conditions or costly health problems, as long as that state set up “high-risk pools” that could instead help cover the cost of care.  Proponents say this would lower premiums for healthy individuals, but critics say it would dramatically drive up costs for those who are seriously ill. Democrats, along with many Republicans, have argued that the popular preexisting protections should stay as they are.

In an interview with CBS News's “Face the Nation” that aired Sunday morning, Trump said “this bill has evolved” over the past several weeks and will “beautifully” protect those who have preexisting medical conditions. He highlighted the proposal to set up high-risk pools — but he also repeatedly seemed to suggest continuing the current mandate.

“Preexisting conditions are in the bill — and I mandate it. I said, 'Has to be,'" Trump said, later adding that the proposal has “a clause that guarantees” protection for those with preexisting conditions.

At another point in the interview, the president said, “Preexisting is going to be in there, and we're also going to create pools, and pools are going to take care of the preexisting.”

When asked to clarify the president's comments, White House press secretary Sean Spicer said that under the current proposal, the changes being discussed would apply only to those who don't have continuous health insurance coverage. Spicer did not directly say whether the president supports this approach or whether Trump instead wants to keep the full protections in place.

“The waiver would allow states to take different approaches to incentivize people to obtain coverage before they fall ill,” Spicer said. “Under Obamacare's rules, many people are waiting until they need significant medical services before they buy insurance.”

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Trump's comments illustrated the internal struggle Republicans are going through in their drive to meet the sometimes conflicting promises of lowering premiums and yet maintaining certain coverage requirements such as preexisting conditions. Trump and the vast majority of congressional Republicans regularly promised that their bill replacing the Affordable Care Act, or Obamacare, would maintain the provision protecting those with preexisting conditions.

But as House Republicans struggled to find votes for the repeal-and-replace legislation, Ryan agreed to support an amendment backed by a bloc of staunch conservatives that would allow states to opt out of these coverage requirements. This amendment was negotiated by the chairmen of the House Freedom Caucus and the Tuesday Group — the most conservative and moderate caucuses, respectively, among Republicans — and it won near-unanimous backing from the Freedom Caucus. However, many members of the Tuesday Group and other corners of the House GOP fear that it goes too far and reneges on campaign promises. Dozens of House Republicans have either outright opposed the proposal or are withholding support.

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For example, Rep. Ryan Costello (Pa.) voted for the original GOP health legislation in the Energy and Commerce Committee in mid-March but last week announced his opposition to the bill because of the new amendment. Costello's suburban district, west of Philadelphia, is one of 23 held by a House Republican that Trump lost last year.

Democrats have said that the latest proposal does not provide anywhere near enough subsidies for the high-risk pools to ensure that those with preexisting conditions do not face skyrocketing premiums.

On NBC's “Meet the Press,” Vice President Pence touted that proposal and singled out Maine's use of the high-risk pools last decade to protect those at the most risk in terms of health. Maine's two senators — Susan Collins (R) and Angus King, an independent who caucuses with Democrats — appeared on the show after Pence and noted that their state's high-risk pool was well funded through a large assessment on every health-care plan in the state and that it was left with a $5 million surplus when it ended because the ACA replaced it.

“It's all in the details, because what's being proposed doesn't have the subsidy, for example, that made the Maine high-risk pool successful,” King said. “It's worth looking at, but I don't think it is a panacea, and I don't think it necessarily is an easy answer to the dilemma of preexisting conditions.”