The Health 202: Preexisting Conditions


https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/10/12/the-health-202-republicans-play-defense-on-preexisting-conditions/5bbf91061b326b7c8a8d194b/?utm_term=.1a2bca86b60d

THE PROGNOSIS

With less than a month before the midterm elections, endangered Republican lawmakers are mounting a defense against attacks they’re trying to dismantle a core element of the health-care law they fought to eliminate.

Democratic candidates on the campaign trail now regularly accuse Republicans of wanting to take away health-care protections for people with preexisting conditions. They’ve pointed to a lawsuit brought by 20 attorneys general in Republican-led states aiming to overturn the Affordable Care Act as proof the GOP wants to let such protections go down with the health-care law. That’s after Republicans whiffed in their effort to repeal and replace the ACA  last summer.

Vulnerable Republican contenders are responding to the slams by airing campaign ads saying they embrace this portion of the ACA. They’re also introducing a wave of bills in Congress they say would protect those with prior illnesses from losing access to affordable health care. But experts question the efficacy of those measures, saying they seem more designed as protection against Democratic attacks than significant policy solutions, as I helped report in a story with Colby Itkowitz this week.

In August, 10 Senate Republicans, including Sen. Dean Heller of Nevada, one of the most vulnerable GOP senators facing reelection in November, sponsored a bill to guarantee protections for patients with preexisting conditions regardless of whether the ACA is struck down in court.

The bill, spearheaded by Sen. Thom Tillis (R-N.C.), would guarantee that insurers sold plans to individuals regardless of whether they have preexisting conditions. But critics and health-policy experts contend the bill leaves a loophole that would exclude coverage for certain services associated with those conditions. For example, a person with cancer wouldn’t be denied coverage, but the insurer wouldn’t be required to cover that patient’s cancer treatments.

Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, explained the Justice Department’s argument in the Texas lawsuit that certain provisions of the ACA should be thrown out, including a “preexisting condition exclusion prohibition.”

Levitt said that such exclusions were common before Obamacare. While Tillis’s bill would restore some parts of the ACA if the Texas lawsuit is successful, it wouldn’t change rules that prohibit insurers from excluding coverage for those with prior illnesses.

“The thing about insurance regulation is it’s kind of like plumbing: A small leak becomes a big leak,” Levitt said. “Insurers would take advantage of that loophole.”

Tillis spokesman Daniel Keylin pushed back on those criticisms and said they are based on an assumed outcome of the Texas lawsuit.

Keylin said there have been “misleading and inaccurate claims made about this bill, claims that assume the courts will strike down the entirety of the Affordable Care Act in Texas versus United States.”

Keylin said the Tillis bill wasn’t meant to be “comprehensive health-care legislation,” or the “totality of Congress’s answer to the Affordable Care Act falling.”

“There is obviously no ironclad way to precisely predict how the court will rule. However, this legislation is an important preemptive step toward getting feedback, hashing out ideas, and underscoring the importance of protecting Americans with preexisting conditions,” Keylin said

He said Tillis would consider “modifications or amendments” to the measure if the court ruling goes beyond what the bill addresses.

On the House side, Rep. Steve Knight (R-Calif.), locked in a tight race in California’s 25th district, introduced a bill last month similar to Tillis’s proposal. Two other vulnerable Republican congressmen also introduced nonbinding resolutions affirming their support for protecting those with preexisting conditions, though neither contains substantive policy solutions.

Iowa Republican Rep. David Young’s resolution says regardless of what happens to the ACA, Congress should retain protections for preexisting condition. Texas Republican Rep. Pete Sessions’s resolution says states should be allowed the authority to restructure their individual health-care marketplaces, but should ensure people with preexisting conditions can access affordable coverage.

“It seems not to be politically acceptable anymore to be against protecting people with preexisting conditions,” Levitt said, pointing to all the Republican proposals. “If you look at an example, like Sen. Tillis’s bill, it shows how wide a gap there can be between a state of desire to protect people and the reality of what an actual piece of legislation does.”

For their parts, spokespeople for Young and Sessions said the congressmen’s views on protecting patients with certain conditions are not new. In a statement, Knight said he has “always advocated” for such coverage.

“He’s always been supportive of protecting preexisting conditions going back to the [American Health Care Act]. This is just another step,” Young spokesman Cole Staudt said.  “This is not a new position for him.”

Sessions, Young and Knight voted to repeal the ACA, though Young co-sponsored an amendment to the Republican bill that would have buffered the impact of the repeal on people with preexisting conditions. Staudt added  that Young would consider introducing  legislation in the future depending on the outcome of the Texas lawsuit.

Yet Joel Ario, managing director of Manatt Health and former director of the Health and Human Service’s Office of Health Insurance Exchanges, said any proposal that “deviates from what was originally in the ACA as a single risk pool concept is going to disadvantage people with preexisting conditions.”

He pointed to Republicans’ record opposing individual pieces of Obamacare, pointing to the elimination of the individual mandate in the GOP tax overhaul:  “Anybody who voted for the mandate repeal voted against people with preexisting conditions,” he said.

Ario called GOP messaging ahead of the midterms a response to public polling that shows how important preexisting condition coverage is to voters.

“Republicans are trying to play into public support for protecting preexisting conditions,” he said, adding they’re “ignoring the fact that their previous action disadvantaged people with preexisting conditions.”

 

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