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Senate bill would undo Trump rule that dismantled healthcare coverage for preexisting conditions

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The Trump administration issued changes to the 1332 waiver guidance in 2018 in its effort to undermine preexisting condition protections that millions of Americans rely on.

On Jan. 14, on its way out the door, the Trump administration cemented the 1332 wavier guidance, giving states the green light to use taxpayer dollars to push “junk” health insurance plans that cost more and cover less. Under these plans, insurance companies can charge people more if they have a preexisting condition, can deny specific benefits – or can deny coverage altogether.

In 2019, Sen. Mark Warner (D-VA) led the Senate Democratic Caucus in introducing a resolution to force an up-or-down vote to reverse the Section 1332 rule changes that was ultimately defeated by the Republican-led Senate.

Warner on Tuesday led Senate Democrats introducing the Protecting Americans with Preexisting Conditions Act of 2021 in an effort to undo the Trump-era rulemaking and guidance that, if fully enacted, would destabilize the Affordable Care Act health insurance market, weaken protections for Americans with preexisting conditions, and increase costs for millions of individuals with quality health plans.

“In the midst of an unprecedented health crisis caused by COVID-19, we should make it easier, not harder, for more Americans to get access to affordable health care coverage. Unfortunately, the Trump administration used every tool at their disposal to undermine the success of the Affordable Care Act, including by flooding the health insurance market with plans that don’t offer protections for the 30 million Americans who’ve been diagnosed with COVID-19,” Warner said. “With millions of Americans diagnosed with COVID-19 – a disease that can cause long-term lingering effects and complications long after recovery – we hope to provide peace of mind for individuals searching for affordable health care coverage that meets their needs.”

The bill boasts the support of numerous organizations, including the American Heart Association, Cystic Fibrosis Foundation, Alliance for Retired Americans, Virginia Poverty Law Center, Commonwealth Institute, March of Dimes, Hemophilia Federation of America, American Cancer Society Cancer Action Network, Susan G. Komen, National Hemophilia Foundation, Leukemia & Lymphoma Society, National Patient Advocate Foundation, Protect Our Care, Cancer Support Community, Planned Parenthood Federation of America, Families USA, American Federation of State, County and Municipal Employees (AFSCME), American Lung Association, the Asthma and Allergy Foundation of America, and the Association of University Centers on Disabilities (AUCD).

“The importance of ensuring individuals have access to high quality, comprehensive and affordable health insurance coverage cannot be overstated,” said Lisa Lacasse, president, the American Cancer Society Cancer Action Network. “COVID-19 has certainly shone a spotlight on the impact of not having access to care for millions of people. However, the need for health insurance is not only about the current pandemic. This bill takes a critical step to help ensure individuals have the coverage they need when they need it, helping to reduce cancer disparities and improve cancer outcomes.”

“People with bleeding disorders and other serious health conditions rely on comprehensive health care coverage and stable insurance markets. HFA is pleased to support this bill which would roll back harmful guidance and rules released over the past three years, restoring key guardrails around the section 1332 waiver process,” said Sonji Wilkes, vice president for policy and advocacy, Hemophilia Federation of America.

“The Protecting Americans with Preexisting Conditions Act would overturn dangerous CMS guidance that allows states to undermine critical protections for millions of Americans living with pre-existing conditions. Under the guidance issued in 2018, ‘state innovation waivers’ could allow for the sale of cheap, inadequate health insurance plans that can deny coverage for individuals with pre-existing conditions, charge them more for being sick or retroactively rescind coverage. We thank Senator Warner for championing the patient protections under the Affordable Care Act that are strengthening access to life-saving care, and we urge lawmakers to support this important legislation,” said Emily Holubowich, vice president of federal advocacy, the American Heart Association.

“The Virginia Poverty Law Center thanks Sen. Warner for filing the Protecting Americans with Preexisting Conditions Act of 2021.  This legislation would reverse harmful actions taken by the previous administration and ensure that all consumer protections under the Affordable Care Act continue in states seeking certain waivers.  All consumers, especially lower income and vulnerable people with chronic health conditions, need and deserve these protections,” said Jill Hanken, health attorney, Virginia Poverty Law Center.

“The Asthma and Allergy Foundation of America (AAFA) is proud to support the Protecting Americans with Preexisting Conditions Act of 2021. Access to quality, affordable health care coverage is critical to Americans with preexisting conditions like asthma and plays an important role in addressing health disparities. Inadequate health insurance coverage remains unequally distributed along racial and ethnic lines, contributing to inequity in health outcomes. We thank Senators Warner, Cardin, Shaheen, and Baldwin for ensuring continued protections for individuals with preexisting conditions,” said Kenneth Mendez, president & CEO, the Asthma and Allergy Foundation of America.

“For more than a decade, cancer patients have relied on the vital protections provided by the Affordable Care Act. Recent regulations expanded and promoted access to subpar insurance products, including Association Health Plans and short-term, limited-duration insurance (STLDI), which have undercut important patient protections and may leave patients vulnerable. These regulations also permitted states to use taxpayer dollars to subsidize inadequate insurance, exposing patients and consumers to greater risk while simultaneously increasing premiums for those who rely on the comprehensive coverage. This legislation is an important step in reining in subpar insurance and a critical component of ensuring patients have access to high-quality, affordable health insurance. We applaud Senator Warner for his leadership on this issue and look forward to working with Congress to protect the millions of Americans who live with a pre-existing condition,” said Gwen Nichols, M.D., chief medical officer, the Leukemia & Lymphoma Society.

A copy of the bill text can be found here.


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