Bustos Helps Pass Legislation to Lower Health Care Costs, Protect Illinoisans with Pre-Existing Conditions

Patient Advocates, Hospitals Speak Out in Support of House Democratic Legislation – Against White House Health Care Sabotage

WASHINGTON – Fighting back against Washington Republican efforts to raise costs for Illinoisans, Congresswoman Cheri Bustos (IL-17) helped pass legislation to protect affordable care for people with pre-existing conditions. Congresswoman Bustos and House Democrats passed H.R. 986 – the Protecting Americans with Pre-Existing Conditions Act of 2019. This bill would reverse sabotage by the Trump Administration that weakened standards on affordability, comprehensiveness and coverage of health insurance plans.

“It’s simple – the White House’s actions will undermine patient protections and make health care more expensive when folks get sick,” Congresswoman Bustos said. “That’s why this week, the House has taken concrete actions to lower the cost of health care and prescription drugs for all Americans. Now it’s up to the Senate to follow our lead. But if Mitch McConnell continues to be the self-proclaimed ‘grim reaper’ for our bills to bring down the cost of health care, it’s the American people who will suffer from his partisan gamesmanship.”

BACKGROUND

Last fall, Washington Republicans continued their ongoing assault on Americans’ health care by issuing new, dangerous guidance on Section 1332 waivers, allowing states to undermine the Affordable Care Act’s critical patient protections for people with pre-existing conditions. Among other provisions, the guidance allows states to promote junk insurance plans that discriminate against people with pre-existing conditions and do not cover essential benefits – exposing patients to astronomical costs if they get sick.

Specifically, the Trump Administration’s guidance would:

  • Raise health care costs. The guidance also allows states to direct ACA subsidies towards short-term plans and association health plans, which could seriously destabilize the risk pool for both Marketplace plans and ACA-compliant plans offered outside the Marketplaces. This would drive up premiums for individuals who need comprehensive coverage, and cause insurers to withdraw from the individual market.
  • Promote plans that lack coverage for pre-existing conditions. The guidance states that the Administration will “consider favorably” state proposals that promote short-term plans and association health plans. In contrast to ACA plans, short-term plans can deny coverage or charge higher premiums based on people’s health status and pre-existing conditions. They also exclude coverage of any care related to a pre-existing condition. Both short-term and association health plans can charge far higher rates to older people than ACA plans can, and neither type of plan must cover the ACA’s essential health benefits. States would now be allowed to expand these plans and count them as coverage, so long as individuals have “access” to comprehensive coverage.
  • Reduce the benefits that health plans cover. The new guidance would allow states to have fewer people enrolled in plans that provide essential health benefits (EHBs), like maternity coverage, mental health care or prescription drugs. States must merely show that at least as many people will have “access” to comprehensive coverage — in other words, show that such coverage is available, even if far fewer people can afford it or enroll in it.

There are nearly 5.5 million Illinoisans living with pre-existing conditions.

Here’s what patient advocates are saying about the Protecting Americans with Pre-Existing Conditions Act and the White House’s actions to raise costs and undermine health coverage:

AARP

“AARP is pleased to endorse H.R. 986, the ‘Protecting Americans with Preexisting Conditions Act.’ On behalf of our nearly 38 million members and all older Americans nationwide, we applaud the House for taking this important step to address the adverse impacts that recent administrative changes to the Affordable Care Act (ACA) have had on health insurance for all Americans, especially those age 50-64.

“[…] For older people, a critical aspect of these consumer protections is the prohibition on denying coverage or charging higher rates for preexisting conditions and the prohibition on charging older individuals more than 3 times the rate of the youngest. The 3:1 age rating provision is crucial in protecting older people from paying an ‘age tax,’ essentially having to pay exorbitant rates for health insurance coverage simply because of their age. Prior to enactment of the ACA, health insurance carriers were allowed to charge rates that were often five or ten times higher, effectively rendering health insurance unaffordable to older Americans seeking coverage in the individual market.”

American Cancer Society Action Network:

“ACS CAN strongly endorses this legislation. […] Our organizations are deeply concerned that the guidance undermines the plain language of Section 1332 and its protections for patients with serious, acute, and chronic conditions. The new guidance does not meet our standards for affordable, accessible and adequate coverage and puts the individuals that we represent at financial and medical risk.

“The Administration’s guidance will make it easier for states to use federal taxpayer dollars to promote sub-standard plans that do not provide comprehensive and affordable coverage. This policy tips the scales in favor of insurance products that are inadequate to meet the needs of millions of Americans with pre-existing conditions. It further appears to condone waiver programs that make it harder for vulnerable residents to enroll in affordable, comprehensive coverage. These changes could lead to a bifurcation of the market and make comprehensive coverage unaffordable for patients who need it to manage pre-existing conditions like pregnancy, cancer, and heart and lung disease.”

Federation of American Hospitals:

“We are supportive of H.R. 986. The legislation seeks to address recently enacted policies that will make it harder for individuals to obtain meaningful health care coverage. […] Specifically, the FAH opposes the revisions to the implementing guidance to Section 1332 of the ACA as we believe the changes are not consistent with either the spirit or the meaning of the law and appear to be intended to encourage more enrollment in plans that do not cover a minimum set of essential benefits. We believe that this guidance, if acted on by states, will do great harm to the individual market, undermining its overall stability.”

American Lung Association:

“[…] The guidance allows states to take away critical protections for patients with pre-existing conditions, instead pushing them towards plans that provide inadequate coverage, such as short-term limited duration plans, which do not provide the coverage patients with chronic lung diseases need to manage their disease.”

AFSCME:

“On behalf of the members of AFSCME, I ask you to support the ‘Protecting Americans with Pre-Existing Conditions Act of 2019,’ (H.R. 986), which will help stop actions by the Trump Administration to undermine the consumer protections in the Affordable Care Act (ACA). The Administration’s guidance radically redefines key terms and criteria for approving waivers, which endangers protections for individuals with pre-existing conditions. […] The Administration guidance lets states set up and subsidize insurance markets with less rules and that can offer short-term health plans alongside ACA-compliant plans. […] Insurers offering these plans can deny or fix the price for coverage based on a person’s pre-existing conditions or age. Insurers will steer healthy consumers to less-regulated coverage. This will drive up premiums for people with pre-existing conditions as more people with costlier conditions and fewer healthier individuals will be in ACA-compliant plans.”

Additionally, a coalition of nearly 30 leading patient and health care advocacy groups expressed strong opposition to the Trump Administration’s guidance. Read the letter HERE.

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