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New Legislation Dealing with Pre-existing Conditions is Not What it Seems

Last week Sen. Thom Tillis (R-NC) and others introduced the Ensuring Coverage for Patients with Pre-Existing Conditions Act. This bill would amend the Health Insurance Portability and Accountability Act to supposedly guarantee the availability of health coverage. The sponsors of the legislation claim that the bill protects people with pre-existing health conditions by prohibiting discrimination based on health status. This protection would purportedly be guaranteed even if the Affordable Care Act (ACA) repeal lawsuit led by Texas is successful (oral arguments for the Texas lawsuit are set to begin on September 10th).

This bill’s guaranteed issue and protection for people with pre-existing conditions only sounds good until the details are considered. Under the proposed legislation, it is true that people with pre-existing conditions may be able to buy a plan. However, insurers would not be obligated to actually cover treatment costs associated with their health condition. Obtaining and paying for insurance wouldn’t actually mean receiving coverage. A health policy advisor for Senator Brian Schatz tweeted “Let’s say you have cancer. Under this bill, you can buy health insurance, but that plan doesn’t have to cover your cancer treatment.”[1]

Many other Affordable Care Act coverage and consumer protections are also not included. Larry Levitt, an executive at the Kaiser Family Foundation tweeted that "So-called 'pre-existing condition exclusions' were common in individual market insurance policies before the ACA, and are also typical in current short-term policies. The new Republican bill would allow them, making guaranteed access to insurance something of a mirage.”[2] Senator Susan Collins is quoted as saying "I do support the objective of it, but the problem is it doesn’t deal with essential benefits like maternity care and treatment of substance abuse and some of the other consumer protections of the [Affordable Care Act] that I think are important.”[3]

It is clear that this bill won’t ensure that people who need coverage the most will be able to get it.  

GAO Report Critical of HHS ACA Open Enrollment Actions

Also last week, the Government Accountability Office (GAO), issued a report highlighting the unfortunate way HHS handled ACA open enrollment. GAO found that HHS did not develop enrollment goals for 2018, the funding process used for Navigators was based on unreliable data, and that refusal to pay cost-sharing reductions drove up premiums in silver plans. The report also highlighted that some stakeholders interviewed by GAO agreed that consumer confusion created by the Administration’s lack of support likely detracted from enrollment.

As we approach the upcoming open enrollment period, it is time for the Administration and Congress to provide real assistance to consumers who need quality coverage. It is past time to end attempts to weaken the ACA, and limit true access to health coverage, through legislation, executive action or the courts.     

See GAO report: https://www.gao.gov/products/GAO-18-565

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