Contrary to popular belief, both Democrats AND Republicans have had a long history of ensuring that Americans have access to coverage for preexisting conditions. In fact, a bipartisan piece of federal legislation requiring coverage for preexisting conditions existed long before the implementation of the ACA – Affordable Care Act, known colloquially as “Obamacare”. Public law 104-191also known as HIPPA – Health Insurance Portability & Accountability Act – of 1996 outlined in sections 2741, 2742 and 2744 the role that both health insurers and state regulators must play in ensuring coverage for those with preexisting conditions. That law was supported by both Democrats AND Republicans for more than decade before Obamacare.
Not long after HIPAA was signed into law, states began developing one or more state run risk mitigation mechanisms to ensure that those in the individual health insurance marketplace were ensured access to coverage for preexisting conditions. 35 states decided to develop High Risk health insurance pools. In Illinois, our High Risk health insurance pool was called ICHIP – Illinois Comprehensive Health Insurance Plan. The existence of ICHIP ensured that Illinois residents who purchase their own individual health insurance were guaranteed coverage for preexisting conditions long before Obamacare. In order to qualify for ICHIP coverage one would have to have been denied coverage from a health insurer in the individual marketplace due to a preexisting condition or have exhausted COBRA continuation coverage from a former employer. If that individual applicant had kept consistent health insurance coverage without a lapse of more than 63 days, they were guaranteed immediate coverage from Blue Cross Blue Shield of Illinois via ICHIP. If they had a lapse in coverage of more than 63 days, they would have to wait up to 6 months before preexisting conditions would be covered. These regulations provided a strong impetus for consumers to keep consistent health insurance coverage in place. This prevented applicants from ‘gaming the system’ by waiting until they were sick to purchase health insurance coverage.
10 other states chose to implement an “Individual market guaranteed issue mandate.” Under this state run risk mitigation system, residents of those states were guaranteed coverage for preexisting conditions from a variety of health insurers operating in that state. For example, in the state of Ohio, there were multiple health insurance carriers that had to “guarantee issue” 4% of their block of business to people with preexisting conditions during an annual ‘open enrollment’ period. During this annual open enrollment period, each health insurance carrier had to report to the Ohio Department of Insurance as to whether or not they “met their 4% guarantee issue quota”. Once one health insurer met their 4% quota, all future applicants with preexisting conditions were then referred to one of the other health insurers operating in Ohio who had not met their 4% quota and those remaining applicants would then be guaranteed coverage from that carrier. Under this innovative and intelligent state run risk mitigation system, all health insurers in the state shared the risk and everyone had access to coverage for preexisting conditions. Again, long before Obamacare. See page 10 of the Ohio “Guide to Health Insurance”
To learn more about consumer protections under HIPAA law, download
“Protecting Your Health Insurance Coverage” from CMS –
Centers For Medicare and Medicaid Services.
Republicans allocated more $100 billion to ensure coverage for preexisting conditions
The aforementioned preexisting solutions to preexisting conditions were only two of the types of protections that could have been implemented had the House Republican’s “American Health Care Act” survived Senate scrutiny or, if the Senate “Better Care Reconciliation Act” had survived John McCain’s 2 a.m. thumbs down vote. Both bills provided solid protection for consumers with preexisting conditions. Page 45 of the American Health Care Act created the “Patient and State stability fund” which outlined on page 51 more than $100 billion over the first 8 years for states to re-establish state run High Risk health insurance pools or other state and federally run risk mitigation systems. This is nothing new. In fact, our Illinois health insurance exchange is a state/federal partnership exchange. Both entities working together to ensure coverage for preexisting conditions.