Julie Rovner, Kaiser Health News
One of the most well-liked options of the Affordable Care Act is its assure of insurance coverage protection — at no larger price — for folks with preexisting well being circumstances.
Thus, even because the Trump administration argues before the Supreme Court that all the Affordable Care Act must be declared invalid, the president and his administration officers preserve that no matter what occurs to the ACA, they’ll shield individuals who have had well being issues prior to now.
Speaking to a “virtual health summit” sponsored by the political newspaper The Hill, Health and Human Services Secretary Alex Azar answered a query in regards to the case, Texas v. Azar, by declaring “it’s in statute already in HIPAA that preexisting conditions are covered,” implying that if the ACA have been declared unconstitutional, these protections would stay in place for everybody.
Umm … not a lot.
When we checked with HHS for extra details about Azar’s remark, a spokesperson reiterated the secretary’s assertion, including that Azar was “clear that the story on preexisting conditions doesn’t end with HIPAA” and that affordability is a important part.
So we investigated.
A Little About HIPAA
The Health Insurance Portability and Accountability Act, a law we now have examined earlier than, was handed by a Republican-led Congress and signed by Democratic President Bill Clinton in 1996. It is finest identified for safeguarding medical privacy and affected person entry to medical data, although the privateness provisions have been added towards the top of congressional deliberations.
HIPAA’s unique goal was to finish what was referred to as “job lock,” a scenario wherein folks with preexisting circumstances have been reluctant to go away jobs with medical insurance even for different positions with medical insurance for worry their circumstances wouldn’t be lined or they’d be topic to lengthy ready intervals for protection. Both eventualities have been widespread on the time.
HIPAA addressed that drawback — so long as folks maintained “continuous” protection, outlined as having medical insurance for not less than 12 months and not using a break of greater than 63 days. People who met that requirement couldn’t have ready intervals or denials of protection imposed upon their very own or a member of the family’s preexisting situation. HIPAA included protections for folks with protection within the small-group insurance coverage market, which primarily contains small companies, by requiring insurers who bought insurance policies in that market to promote to all small teams, no matter well being standing, and to cowl each eligible member of the teams — once more, no matter well being standing.
But HIPAA was not designed to comprehensively deal with the issue of individuals with preexisting circumstances getting and protecting inexpensive medical insurance.
For starters, the protections have been just for individuals who already had job-based insurance coverage, to make it simpler for them to maneuver to different job-based insurance coverage. It did nothing for these within the particular person insurance coverage market who wanted to buy their very own protection — corresponding to self-employed folks and people working for corporations that didn’t provide medical insurance.
HIPAA tried to create a pathway for folks transitioning from employer-sponsored to particular person protection. It ensured that, after leaving a job, individuals who secured insurance coverage by way of one other legislation, the 1986 Consolidated Omnibus Budget Reconciliation Act, or COBRA, can be eligible to purchase a “conversion” plan from their insurer as soon as their earlier job-based advantages have been exhausted.
However, two large issues arose. First, COBRA, which permits people to proceed their employer-provided protection for as much as 18 months in the event that they pay all the premium themselves (plus a small administrative charge), is prohibitively costly for most individuals. In 2019, the average premium for a single employee was $599 per 30 days.
The different drawback was that even when a former employee did have enough money COBRA protection till that 18-month interval ended, there was no restrict on how a lot insurers may cost for the conversion insurance policies. So, even when they have been technically accessible, they have been continuously unaffordable.
There have been different issues. COBRA protection was not accessible to individuals who labored for small companies, or for individuals who grew to become unemployed as a result of the enterprise they labored for failed and now not provided insurance coverage to anybody. HIPAA additionally didn’t stipulate which advantages needed to be provided.
Next, the ACA
The ACA sought to take care of HIPAA’s shortcomings. It required most employers to supply protection and, for these buying their very own, it required insurers to offer a complete package deal of advantages on the similar value to all purchasers, no matter well being standing.
However, the ACA rewrote the HIPAA provisions relating to preexisting circumstances, so if the ACA is struck down by the Supreme Court, it’s not clear whether or not even HIPAA’s lesser provisions would stay. Experts disagree about this, however there’s a chance that HIPAA’s protections may very well be swept away together with the ACA.
Later in his reply to the query posed at The Hill’s summit, Azar identified that there are vital affordability issues with protection below the ACA, as properly. “So we will work with Congress if the time ever comes, to get real affordable solutions,” he stated. That’s true. ACA plans, even with subsidies, will be too expensive for some folks, and prohibitive for individuals who earn simply barely an excessive amount of to qualify for presidency assist. Earlier this month, Democrats within the House passed a bill to make ACA plans extra inexpensive.
Our Ruling
Azar’s assertion urged that if the Supreme Court guidelines towards the ACA and that sweeping legislation is nullified, Americans with preexisting circumstances would proceed to have the protections initially provided below HIPAA.
Though it accommodates a component of reality, it leaves out important items of data. For occasion, the HIPAA protections are usually not equal to these offered by the ACA. First, they’re geared towards individuals who have work-based insurance coverage protection — so long as that protection is steady for not less than 12 months with lapses now not than 63 days. One professional we consulted identified that this window may very well be particularly problematic now, throughout a time of “enormous economic dislocation.”
Additionally, the ACA rewrote the HIPAA provisions relating to preexisting circumstances — bringing into query what would possibly change into of them, too.
We charge Azar’s declare Mostly False.
Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially unbiased program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.
