Should Health Insurers Be Required to Cover Pre-Existing Conditions? (H.R. 6898)

What is H.R. 6898?

(Updated September 6, 2020)

This bill would require that health insurance providers in the individual and group markets accept individuals with pre-existing conditions who apply for coverage. Insurers could only charge beneficiaries higher premiums based on age, tobacco use, the plan’s rating (e.g. a silver plan), and whether the plan covers an individual or family. It would also prohibit insurers from discriminating against participants in a health plan based on their health status and other factors described below.

Specifically, a health insurance plan couldn’t discriminate against participants by charging them higher premiums based on their:

• Health status;

• Medical condition (both physical and mental illnesses);

• Claims experience;

• Receipt of healthcare;

• Medical history;

• Genetic information;

• Evidence of insurability (including conditions arising out of acts of domestic violence);

• Disability;

• Any other health status-related factor considered appropriate by the Health and Human Services Secretary.

A health insurance issuer would only be allowed to deny coverage to an individual or employer if it has demonstrated to state regulators that it doesn’t have capacity to deliver services adequately to those enrolled. The issuer would have to apply that standard uniformly to all employers and individuals without regard to their claims history or any health status-related factor.

Group health plans and health insurers would be prohibited from requesting or requiring a plan participant or their family member to undergo a genetic test. An exception would be made to ask a beneficiary to participate in voluntary genetic research, but that information would be prohibited from impacting their policy or premiums and the research would have to be in compliance with all relevant regulations.

Health plans would be able to offer premium discounts or rebates to participants in wellness programs that reimburse their memberships at fitness centers, reward participation in a diagnostic testing program, encourages preventive care through deductible waivers, or cover the costs of smoking cessation.

Argument in favor

It’s clear that America’s healthcare system needs significant reform in the future, but one thing that shouldn’t change is that insurers should be required to provide coverage to people with pre-existing conditions.

Argument opposed

This bill is an attempt by Republicans to deflect attention from their votes to undermine Obamacare and its protections for people with pre-existing conditions. It’s an empty political gesture.

Impact

Health insurance consumers in the individual and group markets; their employers; health insurance providers; state regulators; and HHS.

Cost of H.R. 6898

A CBO cost estimate is unavailable.

Additional Info

In-Depth: Rep. Steve Knight (R-CA) introduced this bill to ensure that people with pre-existing conditions can access affordable health insurance plans without facing higher premiums as the debate over healthcare reform plays out in the future:

“As premiums, drug costs, and other health costs continue to rise, it’s clear to me that the status quo is unsustainable and our healthcare system must be reformed. However, fundamental disagreements with many parts of the ACA should not blind us from realizing that the law did take certain steps in the right direction in specific areas, particularly in protecting patients with pre-existing conditions and ensuring people won’t be denied coverage because of their health status. A genetic condition, cancer, or other unavoidable situation should not bar an individual from receiving health insurance or treatment that they would otherwise have had access to. A central principle we must adhere to while addressing healthcare policy is increasing competition and choices for patients to drive costs down and quality of care up. At the same time, we should keep in place the insurance protections that patients with any and all health conditions have relied on for the past several years.”

Joel Ario, former director of HHS’s Office of Health Insurance Exchanges, told the Washington Post that Republican proposals such as this are an attempt to deflect attention from their votes to repeal Obamacare, including the elimination of the individual mandate:

“Anybody who voted for the mandate repeal voted against people with pre-existing conditions. Republicans are trying to play into public support for protecting pre-existing conditions… [and are] ignoring the fact that their previous action disadvantaged people with pre-existing conditions.”

This legislation has the support of 14 Republican cosponsors.

Of Note: The individual mandate to buy health insurance imposed by Obamacare was repealed by the enactment of the Tax Cuts and Jobs Act.

Media:

• Sponsoring Rep. Steve Knight (R-CA) Press Release
  
• Washington Post