Senate Republicans introduced a bill last week that would maintain coverage for people with pre-existing conditions in case a lawsuit in Texas wipes out those protections.
However, critics, including Sen. Susan Collins, R-Maine, say the proposal isn't as strong as Affordable Care Act provisions that protect against pre-existing condition restrictions. Collins was one of the key votes against repealing the ACA last year.
Meanwhile, oral arguments on Texas v. United States, a Republican-backed lawsuit involving 20 states, begin next month. The states allege that the ACA is unconstitutional because Congress axed the individual mandate penalty starting in 2019. The Trump administration is not defending the ACA in court, and the Department of Justice recently called pre-existing condition protection and the individual mandate "unconstitutional."
The law just introduced prohibits "discrimination against beneficiaries based on health status, including the prohibition against increased premiums for beneficiaries due to pre-existing conditions," according to a press release from the senators.
"There are strong opinions on both sides when it comes to how we should overhaul our nation's broken healthcare system, but the one thing we can all agree on is that we should protect healthcare for Americans with pre-existing conditions and ensure they have access to good coverage," said Sen. Thom Tillis, R-N.C., who co-sponsored the bill. "This legislation is a common-sense solution that guarantees Americans with preexisting conditions will have healthcare coverage, regardless of how our judicial system rules on the future of Obamacare.”
The bill comes as the GOP faces a dilemma with mid-term elections approaching in November. Most Republicans on Capitol Hill oppose the ACA, but they also know that taking away pre-existing condition protections may cost votes in the fall.
The Texas court case could wipe out the protections, which polls show most Americans support. Removing them would return health insurance to the days before the ACA when insurers could reject or raise rates on people based on their health history.
The state officials taking the law to court allege that Congress stopping the individual mandate penalty starting in January makes the remaining parts of the health law moot. At the very least, the states say, the ACA should not pertain to them.
However, critics say the Republican proposal wouldn't offer much support. Larry Levitt, senior vice president for health reform at Kaiser Family Foundation, said on Twitter the plan isn't nearly as strong as the current law.
A new bill would require insurers to guarantee access for people with pre-existing conditions and prohibit premiums based on health. But, it would allow insurers to exclude any coverage of the pre-existing conditions. A bit of a catch.https://t.co/Dgc1DNor0B— Larry Levitt (@larry_levitt) August 24, 2018
Levitt said the bill wouldn't allow insurers to base premiums on health. However, they could use factors like age, gender, occupation or leisure activities. The bill also provides for pre-existing condition exclusions. In other words, insurance companies would need to cover someone, but could exclude services associated with the pre-existing condition.
"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," Levitt wrote on Twitter.
He isn't the only healthcare policy expert with concerns. In a statement to Healthcare Dive, Joel Ario, managing director at Manatt Health, said, "The Senate bill falls short in not protecting those with preexisting conditions against the rate increases necessary to make up for the loss of a balanced risk pool."
If folks think people with pre-existing conditions should be able to buy plans without discrimination and that those plans should offer comprehensive coverage, I have a piece of legislation for you!— Aisling McDonough (@AislingMcDL) August 24, 2018
It's the Affordable Care Act.