If state legislators want to protect people with pre-existing conditions, they should work to defend and strengthen the Affordable Care Act and help expand access to affordable, comprehensive health insurance.
Since being signed into law, state and federal opponents have tried without success to repeal and replace the Affordable Care Act. All of their efforts would have left millions more uninsured and made deep cuts to Medicaid. The repeal and replace debate following the 2016 elections helped elevate health care as an issue for voters – especially protections for people with pre-existing conditions.
During this past election, Republican lawmakers doubled down on their opposition to the ACA, but also espoused their support for protecting people with pre-existing conditions. They tried to have it both ways – attacking the ACA at the federal level and pledging to protect people with pre-existing conditions at the state level. Throughout the past two years, Wisconsin lawmakers have introduced a few bills aimed at “protecting people with pre-existing conditions.” Although this most recent effort, Assembly Bill 1, is more robust than previous efforts, it still does not provide consumer protections at the same level of the ACA.
No legislation at the state level can take the place of the ACA. For several different reasons states cannot come close to providing as much protection for people with pre-existing conditions. Ensuring affordable, adequate coverage of pre-existing conditions is especially important for people of color who experience pervasive health inequities and are disproportionately impacted by asthma, diabetes, and other chronic conditions.
The first bill introduced in the Assembly this session could provide some benefit to a limited number of people. Assembly Bill 1 requires most insurance companies in Wisconsin to offer coverage to people regardless of their health status and disallows them from charging people more if they have a pre-existing condition. An amendment added to the bill adds more protections because it precludes insurance companies from imposing annual or lifetime caps on health care costs.
Another amendment to the bill narrowed its scope by stating that the bill wouldn’t apply to short-term health plans or so called “junk” insurance which aren’t required to cover pre-existing conditions. The Trump administration greatly expanded access to these plans, which threaten to siphon off younger, healthier people from the ACA Marketplace, which would drive up the costs for everyone else. This change significantly diminished the potential positive impact of the bill. Not only because it restricts which plans are covered by the bill, but also because it undermines the economic stability of the ACA Marketplace.
Nevertheless, AB1 passed the Assembly with strong bipartisan support, and was introduced in the Senate with both Republican and Democratic co-sponsors. Viewed in a vacuum, this bill isn’t bad, but examined in the broader context, state legislation aimed at replacing the ACA likely does more harm than good. It feeds the misperception that states can fashion an adequate replacement for the Affordable Care Act. They can’t.
The main barriers states face in providing similar consumer protections, such as protecting people with pre-existing conditions, are making sure health care covers the services you need when you get sick and making sure that your coverage is affordable. Due to existing federal law, state law cannot regulate nearly half of the people covered by employer sponsored coverage, and perhaps most importantly, states cannot realistically address the issue of making reliable health insurance affordable. We’ve blogged about these issues in depth here and here.
All of the state’s bills fall well short of the level of protection and access provided by the ACA, and all of them send the wrong message that states can fix these issues on their own.
As we’ve said numerous times, there are several things state legislators can do if they want to provide meaningful protections for people with pre-existing conditions. They can limit the sale of short-term, “junk” insurance plans that offer little or no consumer protections, or they can direct the Insurance Commissioner to limit the duration of those plans. Lastly, and perhaps somewhat surprisingly, to strengthen protections for people with pre-existing conditions they can work to expand BadgerCare. That will very likely lower insurance premiums on the ACA Marketplace, extend more affordable coverage to 76,000 Wisconsinites, and save Wisconsin about $15 million per month.
Expanding BadgerCare would also help reduce insurance coverage disparities between white people and Wisconsin residents of color by significantly expanding coverage for people under 138% of the federal poverty level and leading to more people of color being insured. Lastly, they can enable the Attorney General to either withdraw from the lawsuit threatening the ACA and/or join with the other states’ Attorneys General who are defending the law.
To recap, regardless of the particulars of the many bills aimed at protecting people with pre-existing conditions, the bottom line is there is no way for states to adequately replicate the benefits of the Affordable Care Act. Although this most recent bill will help a modest number of Wisconsinites, all of the proposals fall woefully short of the ACA. And all of them risk sending the message that we don’t need the Affordable Care Act to provide meaningful protections for people with pre-existing conditions in Wisconsin. We do.
William Parke-Sutherland