There’s a lot of ass-covering in the latest Republican plan to protect people with pre-existing conditions, but not necessarily a whole lot of actual covering of those people. The plans from Republican Sen. Thom Tillis of North Carolina and Rep. Greg Walden of Oregon aren’t what they claim to be: affordable coverage for people who need it most.
The 2019 plans have done away with the most glaring problem they included in 2018. While insurers couldn’t deny plans to people with pre-existing conditions, they could refuse to cover the treatment of those conditions. That glaring hole has been closed, but the plans still fall far, far short of the comprehensive Affordable Care Act provisions. For example, they don’t include benefits that must be provided, as the ACA does with essential health benefits like maternity or mental health care, or prescription drugs. By leaving out these benefits or making policies that do allow them to be prohibitively expensive, insurers could de facto deny that care while still complying with the law.
The Republican bills also don’t ban insurers from charging more for women than men (the “pro-life” party is fine with adding even more of a financial burden to their forced birth plans). They would also not ban insurance companies from putting caps on how much they pay out in either annual or lifetime benefits. That means someone with a serious illness or accident could blow through their allowed coverage in a matter of months, and be left hanging to pay for care on their own. Both bills have provisions “prohibiting discrimination” based on a person’s health status for either eligibility for coverage or for premium costs, but an expert in writing legislation—a former lawyer in the House Office of the Legislative Counsel, the staff that helps write legislation—says that there are other provisions in these two bills that “could be read as undermining those protections against discriminatory premiums.” For example, the legislation says insurers can’t charge one individual more than another “on the basis of any health status-related factor,” but it is qualified by language saying that this provision shall not be interpreted as restricting how much an employer or individual could be charged. That’s known as a loophole.
A group of 33 patient groups, including the American Heart Association, have written to Senate leaders saying the Tillis bill and its supposed protections “fall far short of the patient protections” that exist under the ACA. It’s also getting panned by Democrats. “The Republican bill does not include critical A.C.A. consumer protections, including community rating, essential health benefits requirements and annual or lifetime prohibitions,” Rep. Frank Pallone Jr. tells the Times. The chairman of the Energy and Commerce Committee continued by saying, “you could theoretically buy insurance if you have a pre-existing condition, but it is very deceptive because the bill will still allow insurers to set premiums based on health status.”
The voting public is a lot more sophisticated when it comes to health care after several years of living with the ACA. After nearly a decade of Republicans doing nothing but trying to destroy it—including with the lawsuit they’re now pursuing—they’re not going to blindly believe Republicans’ promises that now, they care.