Thread by @larry_levitt

A new bill would require insurers to guarantee access for people with pre-existing conditions and prohibit premiums based on health. But, it would allow insurers to exclude any coverage of the pre-existing conditions. A bit of a catch.
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This new Republican bill would prohibit insurers in the individual market from varying premiums based on health. But, premiums could vary based on age, gender, occupation, or leisure activities. Small business premiums could vary based on the health of their workers.

So-called "pre-existing condition exclusions" were common in individual market insurance policies before the ACA, and are also typical in current short-term policies. The new Republican bill would allow them, making guaranteed access to insurance something of a mirage.

It's remarkable how much the ACA has changed the debate over protecting people with pre-existing conditions. Everyone now cares about pre-existing conditions. But, insurance is complicated and the details matter a lot in how real the protection is.

Here's an example of a pre-existing condition exclusion, which would be permitted under the new Republican bill.

Before the ACA, I saw examples of body parts or systems being excluded from coverage for people with pre-existing conditions. For example, an insurer might offer someone with asthma coverage, but exclude any services associated with the respiratory system.

I'll get a little wonky now to explain why this new Republican bill would allow pre-existing condition exclusions, making protections for people with pre-existing conditions something of a mirage.

HIPAA limited pre-existing condition exclusions in employer plans to 12 months, and reduced any exclusions for people with continuous coverage. HIPAA did not limit exclusions for people with individual coverage.

The ACA amended the HIPAA pre-existing condition exclusion language, prohibiting exclusions entirely in employer and individual plans. See 300gg-3.

The Trump administration is arguing in the Texas lawsuit that a bunch of ACA provisions should be invalidated, including 300gg-3, which prohibits pre-existing condition exclusions. The new Republican bill does not reinstate this provision.

Before the ACA, many states limited the length of pre-existing condition exclusions in the individual market to between 6 and 36 months. Others had no limit.
kff.org/other/state-in…