With Obamacare protections for pre-existing conditions facing scrutiny, some Republican senators are positioning themselves to defend the popular healthcare law provision.
In advance of a lawsuit challenging the Affordable Care Act’s protections for pre-existing conditions, 10 Republican senators have introduced a bill that would keep that provision intact. Under the Ensuring Coverage for Patients with Pre-Existing Conditions Act, insurers would be prohibited from declining coverage to anyone based on a previous illness, health status, or ongoing medical needs.
The GOP bill features several important stipulations, however. Although the GOP bill would block insurers from refusing to insure clients with chronic conditions or past medical issues, the measure gives insurance companies the ability to decline to pay for any claims stemming from treatments related to the affliction. Insurers would also be able to set premiums based on age and gender.
Protections for Pre-Existing Conditions Challenged
Though a cornerstone of the ACA, the ban on refusing coverage because of pre-existing conditions has been thrown into question after 20 state governors filed a lawsuit asserting that the entire law is unconstitutional. The suit argues that since the ACA’s individual mandate no longer applies, other provisions, such as the pre-existing prohibition and essential health benefits, should also be struck down.
Scheduled to start on September 5, Texas v. United States has the support of the Department of Justice. Beyond the legal implications, the case could have political ramifications as well. Specifically, vulnerable GOP senators hope this bill preserves a popular ACA provision before the November elections when healthcare is sure to be a major issue in campaigns.
Rallying Public Support
In July, the Kaiser Family Foundation polled 1,200 adults on the issues most important to them when judging a candidate. Defending coverage for pre-existing conditions topped the list, with 63% saying it was “most important” or “very important.”
In addition, if the issue ever came before the Supreme Court, a similar majority of 64% said the court should not repeal it. As for the ACA as a whole, half were not in favor of the court toppling it, according to the Kaiser survey.
If the Texas lawsuit repeals the provision, many who receive insurance through the ACA might not be unable to purchase health insurance going forward. Prior to Obamacare, insurers could deny covering those with pre-existing conditions, ranging from cancer and asthma to acne and diabetes.
Based on 2015 statistics from the Centers for Disease Control and Prevention, about a quarter of adults (27%) between the ages of 18 to 64 would have been denied insurance in the individual marketplace prior to the ACA due to their health history or status, Kaiser estimates.
Other Proposed Changes to Health Insurance Marketplace
After last year’s defeat of an ACA repeal bill in Congress, GOP lawmakers have suggested fixes to the program that include giving states more power over deciding essential health benefits and establishing a temporary reinsurance fund to pay back insurers for major losses.
Additionally, the Trump Administration suspended cost-sharing reduction payments, which enabled insurers to help low-income ACA enrollees afford out-of-pocket expenses. At that time, the Congressional Budget Office estimated that without the subsidies gross premiums for an ACA silver plan would increase an average of 20% this year.
In an effort to offer other options besides the ACA, the Trump Administration has proposed lengthening the time period for short-term health insurance contracts from three months to a year. The Administration has also put forth a plan to permit small businesses and independent proprietors to form their own healthcare associations to buy coverage. Both plans would be exempt from several ACA mandates, including providing essential benefits.
What This Could Mean for Clients
With protections for pre-existing conditions threatened, your clients may come to you with questions. Remind them that, at this time, the GOP bill has not yet come before the Senate and the Texas case has just begun. No decisions have been made yet, and it’s difficult to predict what the outcomes will be.Even if the Texas court overturns the pre-existing conditions provision — and that’s far from certain — states may enact their own statutes preventing insurers from denying coverage to anyone with past or present medical conditions. After Congress eliminated the ACA’s individual mandate for 2019, for example, New Jersey instituted its own individual mandate. States might do the same to protect people battling illnesses from being thrown off the ACA rolls.