House & Senate Bills Take Different Paths on Protecting Pre-Existing Conditions

Legislation to protect people with pre-existing conditions has been introduced in both chambers of Congress, but the bills drafted by Senate Republicans and House Democrats approach the issue very differently.

The Senate GOP bill, the Protect Act (S. 1125), aims to ensure that the primary protections for people with pre-existing conditions enshrined in the Affordable Care Act (aka Obamacare) remain in effect if Obamacare is found unconstitutional when the appeals process for the case Texas v. Azar concludes.

Sponsored by Sen. Thom Tillis (R-NC) with 22 GOP cosponsors, the Protect Act would simply prohibit insurers offering group or individual health insurance coverage from excluding enrollees because of pre-existing conditions (known as “guaranteed issue”). It’d also prohibit insurance companies from refusing to cover treatments for a patient’s pre-existing condition, or charging higher premiums because of the pre-existing condition.

While the Senate GOP bill would amend the Health Insurance Portability and Accountability Act (HIPAA) rather than modifying Obamacare directly, House Democrats’ bill would expand on the ACA.

The Protecting Pre-Existing Conditions and Making Health Care More Affordable Act (H.R. 1884) would expand access to Obamacare’s premium assistance tax credits to nearly all Americans (it’s currently capped at 400% of the federal poverty line, which is about $50k for an individual or $103k for a family of four). It would also undo several Trump administration actions that Democrats view as attempts to “sabotage” Obamacare by:

• Preventing small businesses and individuals from obtaining coverage through association health plans (AHPs).
• Reversing the expansion of short-term, limited-duration health plans for consumers, and not allowing tax credit subsidies to be used for such plans.
• Requiring health insurance plans to cover all essential health benefits (EHBs) without allowing the substitution of benefits across benefit categories or limited prescription drug coverage.
• Not allowing states to get waivers for certain aspects of Obamacare by demonstrating that a comparable number of residents will have access to comprehensive coverage if part of the law is waived.
• Increasing funding for the Obamacare navigators program and marketing for the federal marketplace to $100 million per year apiece.

— Eric Revell

(Photo Credit: iStock.com / Rabbitti)