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The GOP Senate Bill’s Hollow Promise To Protect Coverage For Preexisting Conditions

| June 25, 2017

It's making them sick. (Ted Eytan)

It’s making them sick. (Ted Eytan)

Senate Republicans praised the Affordable Care Act replacement bill they presented last week as preserving coverage for people with cancer, mental illness and other chronic illness.

But the legislation may do no such thing, according to health law experts who have read it closely.

Built into the bill are loopholes for states to bypass those protections and erode coverage for preexisting conditions. That could lead to perverse situations in which insurers are required to cover chronically ill people but not the diseases they suffer from.

Depending on what states and governors do, plans sold to individuals might exclude coverage for prescription drugs, mental health, addiction and other expensive benefits, lawyers said. Maternity coverage might also be dropped.

Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.

“The protection your insurance provides could depend a lot on where you live,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. In some states, “over time, [patients with chronic illness] might find it increasingly difficult to find insurance companies that will offer plans that cover their needs.”

The Senate provisions aren’t expected to affect job-based health plans or Medicare for seniors. They would mainly affect the kind of insurance sold to individuals through the Affordable Care Act’s online exchanges, which cover about 10 million people.

Obamacare overhauls in both the House and Senate would also limit spending on Medicaid for low-income people, which analysts say would cause coverage losses for millions.

The Senate legislation, expected to be voted on next week, follows a widely criticized House bill that would also overhaul the Affordable Care Act, in its case giving states the option of denying coverage or raising premiums for those with preexisting illness.

On Thursday Republican Senators touted their bill as avoiding those features.

“I feel comfortable that no one is going to be denied coverage because they’ve been sick before,” said Sen. Lindsey Graham (R-S.C.) The bill “doesn’t change [protections for] preexisting illnesses, which is good,” he said.

Not explicitly. But it still gives insurers a potential way to shrink coverage for the chronically ill, albeit less obviously, said health law scholars.

“There’s nothing in the Senate bill that specifically would allow withdrawal of coverage for a person with a preexisting condition,” said Timothy Jost, emeritus law professor at Washington and Lee University in Virginia and an expert on health reform. “What it does do is allow states to get waivers” allowing exceptions to rules requiring comprehensive coverage, he said.

The Affordable Care Act required carriers to offer “essential health benefits” covering a wide range of services including hospitalization, maternity, prescription drugs and mental health.

Both the Republican House bill and the Senate bill would let states change that rule. Under those measures, states could set their own standards that might not be as generous, allowing insurers to exclude benefits for those with preexisting illness.

“The Senate bill guarantees people with preexisting conditions access to insurance at the same rate as healthy people, but there is not a guarantee that the benefits they need will be covered by insurance,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Obamacare, too, allows states to make exceptions for essential health benefits — but with strict limits. Coverage must be at least as comprehensive as the federal standard, for one thing. The Senate bill contains no such safeguard.

“As long as they can show that it’s budget neutral, states would have a lot of latitude” to cut essential benefits, said Christopher Koller, president of the Milbank Memorial Fund and a former Rhode Island insurance commissioner.

Insurance plans for individuals might again start to look as they did in the days before Obamacare, when they typically excluded coverage for maternity, mental health and substance abuse, health policy experts said.

That’s especially true because the Senate bill would allow governors to lower coverage standards by executive certification — without approval from legislatures, Corlette said. The measure would also permit governors to raise or eliminate Obamacare’s caps on what patients pay annually out of pocket before insurance kicks in. That could make care for preexisting conditions unaffordable even if it’s covered by the plan.

For their part, insurers may heavily pressure states to make such changes, analysts said.

Unlike the Affordable Care Act and the House bill, the Senate bill contains no incentives or inducements for healthy people to maintain medical coverage. That could result in a disproportionately sick group of people buying individual insurance, driving up carriers’ costs and prompting them to seek ways to trim coverage and cut claims.

“If the only people motivated to buy insurance are going to be the ones who really need it, insurers are really going to have a strong incentive to use their benefit design to deter enrollment for the sickest people,” said Corlette.

Jay Hancock and Rachel Bluth

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13 Responses for “The GOP Senate Bill’s Hollow Promise To Protect Coverage For Preexisting Conditions”

  1. Fredrick says:

    Obamacare was also supposed to lower costs for the average American and you were supposed to be able to keep your doctor if you liked your doctor and the other lies told and believed because of the “stupidity of the of the American voters” (that means the liberal left). I guess we will just have to wait until Trumpcare is passed before we can know what is in it. Welcome to the other side of the fence liberals.

  2. snapperhead says:

    It’s not a health care bill…’s a tax cut posing as a health bill to reward their big donors and keep the bribes, I mean re-election campaign contributions, coming.

  3. BlueJammers says:

    Jay and Ruth used quite a few words like “mays” and “mights” and “coulds” and “ifs” in this article. The one word I was looking for was “truth” but I didn’t see it.

  4. Sherry says:

    It was the “maximizing profits” insurance companies that kept everyone from being covered while going to their own doctors. . . NOT the ACA!

    Which is worse. . . not being able to choose your physician, OR. . . NOT having any insurance AT ALL?

    Right On, snapperhead! Trumpcare is a “tax cut” for “billionaires”. . . while it wipes out health care for millions of hard working Americans!!!

  5. Knightwatch says:

    The Republican anti-health care bill is a disaster for the poor, the elderly and those with preexisting conditions. On the other hand, the tax breaks for the wealthy are yuuge! What horrifies me is how some people, like some commenters above, still roll out Republican anti-ACA talking points to rationalize their approval of a bill that will hurt them, their aging parents and their friends and family with preexisting conditions. The clear answer is they’re Republicans and nothing or no one else matters much. It’s far better to be Republican than to think, to share, to care. This is the future of American greatness??

  6. fredrick says:

    Sorry Knightwatch, the new plan helps my family especially children just over 26 who can not afford paying for insurance that does them no good unless they have something catastrophic happen to them (God forbid). They would be better off not working and going on public assistance. Tell me how that makes any sense whatsoever. They deserve a choice in what they want need and what they want to pay for.

  7. Mark101 says:

    Has anyone on here read this bill, I added a link that included the bill noted on CNN. It would take a “read between the lines expert” to decipher it

  8. #Bernie2020 says:


    See below.

    Nancy Pelosi said that because the liberals allowed the GOP to admen the bill 160 times so the final bill was passed and then reviewed in another session. Get a new talking point already. We already know what’s in the bill. Lets hope your not one of the 20 million that lose their ACCESS to healthcare.

  9. The Oracle says:

    Cleaning up the mess left from failed Obama Care. Huge lies told to pass the disaster we call Obama Care. Remember saving $2,500 a year and keeping your doctor and insurance. Remember, you have to vote for it, before you know what’s in it. Most insurance companies have stopped coverage of this mess. Shameful!

  10. #Bernie2020 says:

    Obamcare hasn’t failed it has been sabotaged but it is still saving people money.

    Republican governors refused to negotiate drug prices and expand Medicare thus removing competition. (FLORIDA)

    Insurance companies cancelled policies that did not fit the new requirements instead of honoring the agreements that they agreed on.

    Congress and the Senate have voted countless times to repeal the lawl instead of updating it to work better costing tax payers $45-50 MILLION dollars. (like buying across state lines, different cheaper policies)

    Also just so you know, these insurance companies have made BILLIONS since Obamacare has been the law but now they want more blood from you and I. They are in the business to make money, they don’t care if you live or die.

    But you go ahead and believe what Fox and Trump tell you. Why the GOP voters defends them is beyond me.

    Us Liberals will continue to be the true patriots of this country.

  11. snapperhead says:

    The GOP wishes it could muster a plan as popular as Obamacare. The House plan has a 17% approval rating and the Senate plan I don’t think will poll much higher if at all. Hell, even Orange Julius said it was a “mean” plan.

  12. Sherry says:

    No matter how you slice it and dice it. . . it is still INSURANCE! Do you completely understand the basic premise of “insurance”????? Just like your car insurance. EVERY ADULT must buy it and pay into it . . . even when you are healthy and don’t think you need it. Then, when that catastrophe comes along, you will not “loose” everything you own or be in debt the rest of your life to pay those “exorbitant” hospital, doctor and prescription bills. Don’t you get that??? You and your kids cannot just go out there and buy insurance AFTER they have had that tragic accident. . . anymore than you can buy car insurance only after a car collusion!!!

    If you and your kids only want to pay for insurance when you feel like you need it. . . “good luck with that”! It’s called living a very high risk life with NO real insurance, along with a high risk of medical bills and law suits.

    As for those who are intelligent and educated enough to understand such things. . . We are all in this together. Although my husband and I are on “Medicare”. . . not “Medicaid”. . . we are compassionate and wise enough to support those who are struggling and need “universal” health care for “ALL”!

    Great coverage, at a reasonable price. . . a system similar to “Medicare” for ALL is exactly what we need! You all know this! But, because the insurance companies, drug companies et al lobby (AKA BRIBE) our government representatives to preserve the massive profits. . . that will never happen. . . because YOU vote the “party line” instead of for what’s best for the American people, and even your own self interest!! .

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