Senate bill makes protections for pre-existing conditions ‘meaningless’

June 26--Although the Senate Republican health care bill doesn't explicitly eliminate the protection for consumers with pre-existing health conditions to buy health plans, some say it's now meaningless.

Under the Affordable Care Act, consumers with pre-existing conditions could not be denied coverage.

In the 142-page draft Senate bill released Thursday, Republicans give states, particularly governors, the authority to choose what benefits are required in health insurance plans. That could result in lack of essential coverage or costly coverage for those with pre-existing conditions.

Under the Affordable Care Act, insurers were required to cover 10 essential health benefits, including mental health coverage, maternity care, prescription drug coverage and hospitalization.

Under the Senate bill released Thursday, the governor of a state could decide to nix all the benefits protected under the current law.

So although consumers would not be denied coverage because of a pre-existing condition, the services or prescription drugs they need to treat that condition might not be covered.

"The (pre-existing condition) protection is meaningless," Linda Blumberg, a health policy expert with Urban Institute, said of the provision under the Senate bill.

The pressure is there to reduce premiums, and one way to do that is to have the ability to exclude certain benefits.

The essential health benefits under the Affordable Care Act were an important step to set a benchmark across the country on what essentially defined insurance. Having those minimum standards allowed consumers to shop for coverage with the expectation that they knew what was included in health plans.

Ryan Barker, vice president of health policy for the Missouri Foundation for Health, said this aspect of the Senate bill has "huge repercussions" in Missouri, a state that is battling an epidemic of opioid addiction.

Mental health and substance abuse services are required benefits under the current law.

Before the ACA, plans purchased on the individual market could exclude drug coverage or maternity coverage. And without coverage requirements, there's no incentive for insurers to offer certain benefits, according to a report from the Kaiser Family Foundation.

"The difficulty is that insurers would be very reluctant to offer some of these services unless they were required in all policies because people who need these benefits would disproportionately select policies covering them," the report said.

Hospitals are concerned patients will choose policies that don't cover much. Currently, hospitalization for overnight stays and surgeries is a required benefit under the ACA.

"You could end up with people who have worthless policies," said Dave Dillon, spokesman for the Missouri Hospital Association.

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