Health Bill’s Waivers Spark Interest Among Kansas Lawmakers

May 09--TOPEKA -- Some Kansas lawmakers say they are open to pursuing insurance coverage exemptions that would be allowed under the federal health care bill passed by the U.S. House.

But Gov. Sam Brownback and others say it's too early to weigh in on the plan to replace the Affordable Care Act.

Under the bill passed by the House, states could seek permission to allow insurance companies to offer plans without essential health benefits, such as coverage for maternity care and prescription drugs. Individuals with pre-existing conditions could also be charged more for coverage.

State lawmakers who focus on health issues expressed either a desire to pursue waivers or an openness to examining them. Brownback was more circumspect.

"I'm not going to comment on this. They've made multiple runs at Obamacare, so until something really gets more formed, I'm not going to be making comments on it," Brownback said last week before the House vote.

"It's a very difficult thing they're dealing with, trying to repeal an entitlement program. It's a very expensive entitlement program."

The bill, as currently written, would allow states to seek an exemption from the "community rating" rule that prohibits individual insurers from charging sick people more for coverage.

In states that receive federal waivers under the proposal, individual insurers could base the cost of coverage on a person's health status or medical history using a process known as medical underwriting, which was discontinued under the Affordable Care Act.

Rep. Dan Hawkins, R-Wichita, who leads the Kansas House Health Committee, said he would support an exemption from the community rating rule and returning to the use of a high-risk insurance pool in Kansas.

"I'll want that to be put in place, because that's what we should have done in the first place. If we would have done that instead of the ACA, we wouldn't be in the shape we're in right now," Hawkins aid.

The bill earmarks $23 billion to aid individuals who have pre-existing conditions. An analysis from the health care consulting firm Avalere found the amount would cover 5 percent of the total number of enrollees with pre-existing chronic conditions who are in the individual insurance market today.

The firm's analysis said only about 110,000 people with a pre-existing chronic condition would be covered. Some 22,000 people in Kansas have pre-existing conditions and are in the individual market.

"Given the amount of funding in the bill, the program can only afford a few small states to opt into medical underwriting," Caroline Pearson, senior vice president at Avalere, said in a statement. "If any large states receive a waiver, many chronically ill individuals could be left without access to insurance."

Rep. John Wilson, D-Lawrence and the ranking member of the House Health Committee, said he is open to exploring waivers to improve efficiency. He emphasized that no waiver should threaten coverage.

"Any waivers that would minimize coverage or exclude conditions I see as problematic," Wilson said.

The federal legislation has proven divisive and is likely to undergo significant changes in the U.S. Senate. Sen. Jerry Moran of Kansas has said the Senate will "start from scratch."

Key state senators on health policy said it was too early to tell what Congress will do on health care.

Sen. Vicki Schmidt, R-Topeka, chairs the Senate Public Health and Welfare Committee. Sen. Laura Kelly of Topeka is the ranking Democrat on the committee. Both said it was too early to say, given where the bill is in the process.

"We just don't know what it would mean to us," Schmidt said.

Kelly was also reserved.

"We're really putting the cart before the horse here. The ACHA passed the House by a very slim margin. I think it has absolutely zero chance to pass the Senate," Kelly said.

Contributing: Tony Pugh of McClatchy

Jonathan Shorman: 785-296-3006, @jonshorman

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