Scott Tipton: AHCA and pre-existing conditions
May 7, 2017
One of my top priorities is to pass legislation to replace the broken healthcare system created by the Affordable Care Act with one that makes health care affordable and accessible for Coloradans. Too many people who are insured have premiums that exceed their mortgage payments and deductibles north of $6,500 that have to be met before their insurance even kicks in. This is unacceptable and unsustainable.
The House has been working on a bill to repeal and replace the ACA, and throughout the process, I have been adamant that the replacement plan needs to ensure people with pre-existing conditions have access to affordable health insurance. I don't care who you are — we're all going to have a pre-existing condition at some point in our lives.
The American Health Care Act provides individuals with pre-existing conditions these assurances. I don't think the law could be clearer about this point. The bill states, word-for-word: "Nothing in this act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with pre-existing conditions."
Under the AHCA, an insurance company would not be able to deny insurance coverage to someone because of their pre-existing condition.
My office has received a lot of questions about the community rating waiver that could be available to states under the AHCA. Community rating regulations under the ACA placed limitations on how much an insurance company could vary insurance rates for individuals in the same geographic area based on their health status. The AHCA does not repeal the ACA community rating regulations.
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The AHCA gives states the ability to seek a waiver from the community rating regulations, but in order to request a waiver, the state must establish a risk-sharing program to ensure uninsured individuals who may be viewed as high-risk by an insurance company still have access to affordable health insurance.
Further, even if a state chooses to seek a waiver and establish a risk-sharing program, any person who maintains continuous insurance coverage cannot have the community rating provision applied to them by an insurance company. To maintain the standard of continuous coverage, a person could not let his or her insurance lapse for more than 63 days, and insurance obtained through an employer, COBRA, Medicare, Medicaid or the individual market satisfies the requirement.
The AHCA has set aside $123 billion for states that choose to establish a risk-sharing program, with an additional $15 billion that can go toward maternity coverage, newborn care, mental health and substance abuse. The state would receive hundreds of millions of dollars from this fund to help offset the cost of insurance premiums for individuals enrolled in the risk-sharing program.
I know the decisions we make in Washington about health care policy will have real-life impacts on you and your family. Coloradans deserve a health care system that provides access to affordable health insurance and health care services. We're working to make this a reality.
U.S. Rep Scott R. Tipton represents Colorado's 3rd Congressional District.