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Trump guarantees protection for those with pre-existing medical conditions — but it’s unclear how

President Donald Trump in March.Andrew Harnik/AP/File

President Donald Trump tried Sunday to reassure anxious Republicans that the latest proposal to replace the Affordable Care Act would continue to protect those with pre-existing 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 states to again permit insurance providers to deny coverage to people who have pre-existing conditions, as long as that state set up ‘‘high-risk pools’’ that would provide coverage to those in poor health who cannot get traditional insurance. Democrats, along with many Republicans, have argued that insurance providers in all states should continue to be required to cover people with pre-existing conditions, a popular mandate that many Republicans had promised to continue.


In an interview with CBS News’ ‘‘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 pre-existing medical conditions. He highlighted the proposal to set up high-risk pools, which could help lower insurance rates for those who are healthier - but he also said repeatedly that the legislation includes ‘‘pre-existing,’’ seeming to suggest an extension of the current mandate.

‘‘Pre-existing is going to be in there, and we’re also going to create pools, and pools are going to take care of the pre-existing,’’ Trump said at one point, later adding that the proposal has ‘‘a clause that guarantees’’ protection for those with pre-existing conditions.

The White House has yet to respond to a request to clarify what the president meant.

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 pre-existing 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 the 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.

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 pre-existing conditions do not face skyrocketing premiums.

On NBC’s ‘‘Meet the Press,’’ Vice President Mike 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, a Republican, 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 ended up with a $5 million surplus when it ended because the ACA replaced it.


‘‘What’s being proposed doesn’t have the subsidy, for example, that made the Maine high-risk pool successful,’’ King said.