More than 25 professional medical and patient advocacy groups have issued a statement responding to new Centers Medicare and Medicaid Services (CMS) guidance that “gives states free reign to undermine critical protections for millions of Americans living with pre-existing conditions.”1

Multiple organizations, including the American Heart Association, the American Diabetes Association, and the National Health Council, have condemned the “dangerous action,” writing that to follow through with the guidance would “take us back to the days when people with pre-existing conditions were openly discriminated against and blatantly denied access to lifesaving care.”1

Published on October 22, a CMS press release outlined the Trump Administration’s latest attempt to thwart the Affordable Care Act (ACA): State Relief and Empowerment Waivers will allow states to “increase choice and competition within their insurance markets” by allowing states to “more flexibly design alternatives to the ACA.”2

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The CMS news release pointed out that Section 1332 of the ACA allows states to waive certain provisions of the legislation, so long as replacement waiver plans meet specific “guardrail” criteria to ensure that the public is able to access coverage that is comparably comprehensive and affordable.

In the press release, CMS Administrator Seema Verma emphasized that these waivers are simply a new approach to state empowerment, and will result in reduced costs alongside higher quality options.

In their statement, however, more than 25 medical organizations disagreed.

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“Issued under the guise of ‘state flexibility,’ the guidance allows states to approve the sale of cheap, inadequate health insurance plans that can eliminate coverage of pre-existing conditions, charge premiums based on health status, or rejects patients altogether.”

The statement also noted that these changes will likely result in increased challenges for consumers in assessing coverage provided by each individual plan. 

“Our organizations advocate for everyone with pre-existing conditions to have access to healthcare that is affordable, adequate, and accessible,” the statement concluded. “We are deeply disappointed that this guidance undermines protections for people with pre-existing conditions, and we urge the Administration to withdraw it immediately.”


  1. CMS guidance puts millions of Americans with pre-existing conditions at risk [news release]. Washington, DC: American Heart Association. Published October 24, 2018. Accessed October 24, 2018.
  2. Trump Administration announces State Relief and Empowerment Waivers to give states the flexibility to lower premiums and increase choices for their health insurance markets [news release]. Baltimore, MD: Centers for Medicare and Medicaid Services. Published October 22, 2018. Accessed October 24, 2018.