Politics & Government

Senate GOP has plan to save pre-existing conditions coverage. ‘A mirage,’ critics say


A group of Republican senators is pushing a plan to assure consumers with pre-existing conditions that they can get health insurance coverage even if Obamacare ends.

But the legislation, critics say, won’t help those who need it the most.

Skeptics maintain it re-creates a loophole for insurance companies to do the sorts of things that prodded lawmakers to adopt Obamacare in the first place.

“If the goal is to protect people with pre-existing conditions, the bill is a bit of a mirage,” said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, a nonpartisan health care research group.

A court challenge by Republican attorneys general seeks to invalidate parts or all of the Affordable Care Act, including the popular provision that individuals with pre-existing coverage cannot be denied health care coverage. Oral arguments in Texas v. United States are set for early September in U.S. District Court in Texas.

Officials from 20 states, all won by President Donald Trump in 2016. argue that since the 2017 Republican-authored tax bill removed the penalty for people without health insurance, the entire law, often known as Obamacare, is now unconstitutional. Democratic attorneys generals from 16 states and Washington, D.C. are defending the 2010 law.

Sen. Thom Tillis, R-N.C., speaks during a news conference about an immigration bill on Capitol Hill, Monday, Feb. 12, 2018 in Washington. Alex Brandon AP

Sen. Thom Tillis, R-N.C., and nine other Republicans have introduced the measure to ease the insurance pain if the law is struck down.

At first glance, it sounds promising for consumers — it would bar discrimination based on health status. It would guarantee availability in the individual or group market for those with pre-existing coverage, the bill’s sponsors say.

“One thing we can all agree on is that we should protect health care for Americans with pre-existing conditions and ensure they have access to good coverage,” said Sen. Tillis said in a statement.

Look again, said critics.

Under the bill, insurers could not decline coverage for people with pre-existing conditions, Levitt said, but it would allow insurers to exclude coverage for anything related to those conditions. “You don’t have to be real creative to imagine how this might work. These pre-existing condition exclusions were typical before the ACA.”

“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,” tweeted Aisling McDonough, a health policy adviser for Sen. Brian Schatz, D-Hawaii.

As many as 133 million people have a pre-existing condition using a broad definition, according to a 2017 estimate by the Department of Health and Human Services. More than 2 million North Carolinians have a pre-existing condition, according to a 2012 study by Families USA, a nonpartisan organization pushing for health care reforms.

Tillis spokesman Adam Webb said that claim that the bill has big loopholes “is incorrect and misleading” and “assumes that the court will strike down” the entire Affordable Care Act.

“This legislation protects Americans with pre-existing conditions so that they cannot be denied coverage or charged more based on health status — two of the central protections contested in Texas vs. United States,” Webb wrote in an email. “In the event that the Affordable Care Act is struck down in its entirety, Congress would put forward a more comprehensive response.”

Kaiser’s Levitt said that while premiums could not vary based on health status under the bill, they could still be adjusted for age, gender, occupation or high-risk activities. The ACA only allowed premiums to vary based on age and tobacco use.

The Affordable Care Act had negative poll numbers from its inception through the end of the Obama presidency. But since the beginning of 2017, it has enjoyed favorable poll numbers, according to Real Clear Politics. A Fox News poll taken this month found that 51 percent approve of the law, while 44 percent disapprove.

The Fox poll also found that health care is the top issue for registered voters with 56 percent calling the issue “extremely” important to their vote and another 30 percent calling it “very” important. A Kaiser Family Foundation poll in June found that 25 percent consider it the top issue in the election, the most of any issue. Among Democratic voters, 33 percent called it “the most important issue.”

The Senate voted down broad and narrow repeals of the Affordable Care Act last year, including with a dramatic early morning July “thumbs-down” vote by Sen. John McCain, R-Ariz.

Given the potential political ramifications, Republican senators have not been enthusiastic about the lawsuit. In June, Sen. Lamar Alexander, R-Tenn., called the argument in the Texas lawsuit “as far-fetched as any I’ve ever heard.

“Congress specifically repealed the individual mandate penalty, but I didn’t hear a single senator say that they also thought they were repealing protections for people with pre-existing conditions,” Alexander said.

Officials from Alabama, Arkansas, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah, Wisconsin and West Virginia have signed onto the lawsuit. All of those states voted for President Donald Trump in the 2016 presidential election.

Officials from California, Connecticut, Delaware, Hawaii, Illinois, Kentucky, Massachusetts, Minnesota, New Jersey, New York, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington and Washington, D.C. are defending the law. All but Kentucky and North Carolina voted for Democratic candidate Hillary Clinton in the 2016 election.

“North Carolinians depend on reliable access to affordable healthcare,” North Carolina Attorney General Josh Stein, a Democrat, said in a statement in April. “Partisan political games should not interfere with people’s ability to live happy, healthy lives. I will oppose any attempt to strip healthcare coverage from hundreds of thousands hard-working people in our state.”

Brian Murphy: 202.383.6089; Twitter: @MurphinDC