Did The ACA Create Preexisting Condition Protections For People In Employer Plans?

Julie Rovner, Kaiser Health News

During a current look on MSNBC, Sen. Chris Coons (D-Del.) answered questions from “Morning Joe” co-host Mika Brzezinski concerning the newest lawsuit difficult the constitutionality of the Affordable Care Act. “The most important part of Obamacare, as you know, Mika, is the protection against preexisting condition discrimination that extended to more than 150 million Americans, folks who get their health insurance through their employer,” he mentioned.

Because, as virtually everybody agrees, well being care is complicated, we determined to take a more in-depth have a look at Coons’ assertion, particularly as a result of a lot has been written and mentioned — and put in marketing campaign adverts — about how many Americans have preexisting health conditions and the way they gained insurance coverage protections beneath the ACA.

We won’t try to evaluate Coons’ assertion that the ACA’s safety for folks with preexisting circumstances is “the most important part” of the legislation, though it’s typically talked about together with the enlargement of Medicaid to thousands and thousands extra Americans with low incomes.

We began out by contacting Coons’ workplace to get the background info on his assertion however didn’t hear again. So, we moved on to inspecting the statutes and speaking to varied specialists.

First Came HIPAA

What we came upon is what few folks notice: Protections for preexisting circumstances for most individuals with job-based insurance coverage predated the ACA by greater than a decade.

The Health Insurance Portability and Accountability Act of 1996, or HIPAA, is greatest identified for its provisions concerning medical privateness and affected person entry to their medical information. But the principal goal of the legislation was to place an finish to what was referred to as “job lock.” That occurred when folks with preexisting well being circumstances had been afraid to go away one job with insurance coverage for an additional job with insurance coverage as a result of the brand new insurance coverage wouldn’t cowl their situation, or would impose lengthy ready durations.

“HIPAA was a big advancement at the time in terms of protecting people with preexisting conditions who had employer coverage,” mentioned Sabrina Corlette, a analysis professor who research medical health insurance at Georgetown University.

Specifically, HIPAA required that so long as somebody had been repeatedly coated by medical health insurance for a minimum of 12 months, and not using a break longer than 63 days, new insurance coverage at a brand new job couldn’t impose ready durations for a employee or member of the family. HIPAA additionally required insurers who bought insurance policies within the small-group market to promote to all small teams, no matter well being standing, and to cowl each eligible member of the group, additionally no matter well being standing.

Most of the states had already tried to handle the job-lock drawback by the mid-1990s, however states couldn’t attain the vast majority of the inhabitants with medical health insurance as a result of they had been coated by the federal Employee Retirement Income Security Act, or ERISA.

“HIPAA basically ratified what most states had already done,” mentioned Joel Ario, a former Pennsylvania state insurance coverage commissioner who helped implement the ACA for the federal authorities.

HIPAA additionally tried to easy the transition from employer-based insurance coverage to particular person protection by requiring insurers to supply protection to individuals who exhausted their post-employment COBRA benefits. (COBRA, brief for the Consolidated Omnibus Budget Reconciliation Act, was a 1986 legislation that allowed staff to proceed to buy their employer plans at full price for as much as 18 months.) But HIPAA didn’t handle how a lot insurers may cost for these plans, and plenty of insurance coverage firms tried to discourage enrollment by making premiums unaffordable for practically anybody who certified.

While the group-to-individual conversion drawback was probably the most evident hole in HIPAA, it was not the one one. HIPAA didn’t require employers to supply well being protection nor did it require those that did supply protection to supply a minimal bundle of advantages.

Most of these gaps had been addressed by the ACA. It successfully required giant employers to offer a minimal bundle of advantages (or else pay a considerable superb). The ACA additionally, for the primary time, required insurers to promote insurance policies to people with preexisting circumstances — with out charging them extra. Much of HIPAA was written into the well being legislation, making the connection between the 2 measures much more difficult.

Our Ruling

In this assertion, Coons prompt that the ACA supplied preexisting situation protections to the greater than 150 million Americans who get their well being protection by their place of employment.

But it’s not utterly appropriate. Those had been already in place by HIPAA, although expanded by the ACA.

We price Coons’ assertion as Half True.

Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially impartial program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.

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