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Our Take: Senators offer plan to (sort of) protect pre-existing conditions

Aug 27, 2018
Ten Republican senators have introduced legislation that purports to protect the Affordable Care Act (ACA)’s provisions for people with pre-existing conditions. The language offering protections would be effected by amending the Health Insurance Portability and Accountability Act.

“There are strong opinions on both sides when it comes to how we should overhaul our nation’s broken health care system, but the one thing we can all agree on is that we should protect health care for Americans with pre-existing conditions and ensure they have access to good coverage,” said Sen. Thom Tillis, R-N.C., one of the bill’s sponsors.

The other sponsors of the bill are Lamar Alexander, R-Tenn., Chuck Grassley, R-Iowa, Joni Ernst, R-Iowa, Lisa Murkowski, R-Alaska, Bill Cassidy, R-La., Roger Wicker, R-Miss., Lindsey Graham, R-S.C., Dean Heller, R-Nev., and John Barrasso, R-Wyo.

Our TakeThis is the one health care story that you probably didn’t hear much about on Thursday when the bill was introduced to the Senate floor. But you will be hearing a lot about it in the run-up to the midterm elections, so we’re here to inform you before the politicians and pundits take their sides.

The bill is a defensive move by Republicans. As previously reported, 20 GOP-led states filed a lawsuit arguing that the ACA is unconstitutional after Congress repealed the individual mandate penalty last year. Following the repeal, the Justice Department said most of the law should stand, except for protections for those with pre-existing conditions.

Some Democrats have been using the lawsuit to rail against Republicans in their election campaigns—accusing the GOP of failing to protect vulnerable patients.

The bill says that insurers can’t deny coverage or increase premiums because of “health status, medical condition (including both physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), disability, [or] any other health status-related factor determined appropriate by the Secretary [of Health and Human Services (HHS)].”

Here’s all you need to know. While the bill does prevent insurers from increasing premiums because of pre-existing conditions, it also allows insurers to exclude coverage of pre-existing conditions.

In other words, insurance companies won’t be allowed to refuse coverage to people who have a history of cancer or those who are pregnant. But they could offer policies that don’t cover cancer treatment or maternity care.

So, under this plan, we would be going back to a time when insurance companies could offer just about anything, and price accordingly, based on age, sex, occupation or just about anything else they think of.

We are just as tired of writing about Obamacare squabbles on the Hill as you probably are reading about them. But getting the facts right on this one is important.

What else you need to know
Seventeen health systems have formed the Medicaid Transformation Project “to identify, develop and scale financially sustainable solutions that improve the health of underserved individuals and families in their communities.” The effort is being led by AVIA, a network of health systems focused on innovation, and Andy Slavitt, former acting administrator of CMS and founder and general partner at Town Hall Ventures. Their focus will be on behavioral health, women’s and infant care, substance use disorder and avoidable emergency department visits. AVIA said the effort is anchored by five systems: Advocate Aurora Health, Baylor Scott & White Health, Dignity Health, Geisinger and Providence St. Joseph Health. Morhere.

One of the nation’s first association health plans (AHPs) will be launching in Nevada on Sept. 1. Three chambers of commerce—Henderson, Boulder City and Clark County—filed notice Friday that they will offer several insurance products to plan members through UnitedHealthcare. The Trump administration has promoted AHPs as an alternative to the state health care exchanges under the Affordable Care Act. Several national business groups have recently voiced opposition to AHPs, with concerns that AHPs don’t have the same consumer protections offered through the ACA. Some states, including Pennsylvania and New York, have issued emergency rules or bulletins warning that AHPs could destabilize insurance markets. More here.

HHS Secretary Alex Azar said Friday that his agency has the authority to eliminate prescription drug rebates. In an interview with Reuters, Azar said the current rules for rebates were created by HHS, noting, “What one has created by regulation, one could address by regulation.” The Office of Management and Budget is currently reviewing a new set of regulations related to rebates; Azar did not comment on when he expected them to take effect. The Trump administration has previously cited rebates earned by pharmacy benefit managers as being one of the causes of high prescription drug prices, which PBMs vigorously dispute. More here.

Cigna shareholders approved the company’s $67 billion acquisition of Express Scripts. Cigna said about 90 percent of its shareholders voted in favor of the deal. “Our combined company will enhance Cigna’s differentiated service-based model, fueled by actionable insights and analytics, to drive innovation and meaningful growth in a highly dynamic market environment,” said Cigna president and CEO David Cordani. “As a result, we will build more effective partnerships, further improve health outcomes and deliver a superior customer experience.” The acquisition remains subject to regulatory approval. More here.

Four of California’s largest health systems have formed the California Health Care Climate Alliance to advise on climate change laws and regulations, Becker’s Hospital Review reported. Dignity Health, Kaiser Permanente, Providence St. Joseph Health and Sutter Health formed the coalition in advance of the Global Climate Action Summit in September, in an effort to bring a health care perspective to climate change. More here.

What we’re reading
Direct Primary Care: One step forward, two steps back. JAMA 8.21.19 (subscription required)
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