This week, the House of Representatives will vote on Rep. Ann Kuster’s (D-N.H.) Protecting Americans with Preexisting Conditions Act (HR 986).
According to the authors of its companion bill in the Senate, the legislation will “prevent the Trump Administration from promoting ‘junk’ health care plans that lack protections for people with pre-existing conditions and would increase costs for millions of Americans.” With roughly 80-percent of Americans expressing support for the coverage of pre-existing conditions, this brief summary of the legislation may seem uncontroversial enough; however, the truth of the matter is that it will limit quality and access of care for some of the most vulnerable of Americans.
On October 24, 2018, due to the diminishing availability of viable options for the many working families, the Department of Health and Human Services, supported by the Department of the Treasury, expanded the scope of Section 1332 of the Affordable Care Act, which allows states to apply for State Innovation Waivers from certain aspects of the law. Kuster’s bill aims to prevent the full force of the new guidelines from going into effect.
However, despite what the title of the bill suggests, the new guidance provided by HHS and the Treasury has not negatively affected Americans with pre-existing conditions. In fact, all protections for those with complications remain 100-percent preserved under the new measure. The only thing that has changed is that more power has been given to the states to create customized, high-quality and affordable plans tailed for the individualized needs of those living within their borders – a move that will expand enrollment and slash premiums.
Even the Affordable Care Act’s most ardent supporters agree that the states are in a better position to address the specific coverage needs of their residents. For example, the left-leaning Families USA has expressed much enthusiasm for Section 1332, calling it “an important vehicle for the next round of state improvements in health care” in 2016. Perhaps the best way the organization showcased the power of the State Innovation Waivers was by releasing a fact sheet in August 2017 on Alaska’s waiver, underscoring how it has reduced costs while preserving all protections for pre-existing conditions.
“Alaska's waiver will not change the way people with pre-existing conditions get care: people with pre-existing conditions will continue to enroll in the same plans as healthy people, receive all benefits, be charged the same premiums as healthy people, and receive premium credits and cost-sharing reductions if eligible,” the organization wrote. “However, the costs of their claims will be paid out of a pool financed by a wider set of payers, bringing down individual insurance premiums for everyone and stabilizing the marketplace.”
Given that the administration’s newly-implemented guidance does not change any of this, there is no reason for organizations and policymakers to change their tune on the 1332 waivers today by advancing Kuster’s legislation.
The results of the State Innovation Waivers speak for themselves. According to the Heritage Foundation, “premiums fell in all seven states that have a 1332 waiver – by as much as 42 percent in Maryland.” Moreover, data pulled from the Centers for Medicare and Medicaid Services (CMS) shows that under the new guidance, not only will premiums continue to fall for all of the states that currently have 1332 waivers approved or implemented in 2019, but that enrollment will also increase for them all as well – by as high as 13-percent in one state.
While federal policymakers can likely do more to protect Americans who suffer from pre-existing conditions, the Protecting Americans with Preexisting Conditions Act is certainly not the answer. This bill will circumvent state autonomy, reduce plan enrollment and pull the rug out from under many Americans who want nothing more than healthcare plans that make sense for them and their families. Despite heated disagreements on healthcare, the outcomes that this legislation will yield are the antithesis of what both sides of the aisle have been working toward. For these reasons, Congress should reject HR 986 outright.
– Benjamin Alli, M.D., Ph.D., is a Sakellarides Professor of Medicine and Surgery and the Chancellor of the Royal College of Physicians and Surgeons of the United States of America.