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The GOP Georgia senator’s new plan offers no details on how protections for people with preexisting health conditions would be ensured.
Two provisions in the plan indicate protections will be less than those provided by the Affordable Care Act, experts say.
Republicans for years have worked to eliminate the Affordable Care Act, the law that established the gold standard for protecting people with preexisting health conditions against discrimination in insurance pricing and coverage.
Now Loeffler, campaigning in one of two Jan. 5 Georgia runoff elections that will determine which party controls the Senate, has advanced a new health care proposal — a "framework" she claims will "ensure Americans with preexisting conditions are protected."
Loeffler’s thinly detailed plan does, too.
"There is nothing in the Loeffler plan that indicates she would support the policies necessary to protect Americans against insurer discrimination," said Jonathan Oberlander, a professor of health policy and management, and of political science, at the University of North Carolina. "The plan is short on details and substance, and long on political posturing."
The existing Affordable Care Act was the first federal law to guarantee that people with health problems could buy their own insurance without paying more than healthier consumers.
Through multiple provisions, it prevents insurance companies from excluding patients with preexisting conditions.
The ACA says carriers "may not impose any preexisting condition exclusion." It backs that up with another section that says they "may not establish rules for eligibility" based on health status, medical condition, claims experience or medical history. Another provision limits the premiums that can be charged to older policyholders.
The Loeffler campaign did not provide us information to back up the senator’s claim that her proposal would ensure these protections.
Loeffler released her four-page "Modernizing Americans’ Health Care Plan" on Nov. 13. As reported by the Atlanta Journal-Constitution, it is a collection of more than one dozen new pieces of legislation sponsored or co-sponsored by Loeffler, along with three measures already signed into law.
The health care experts we spoke with said the plan lacked so many details that they were forced to make assumptions about what it might or might not include.
Joseph Antos, a health care scholar at the market-oriented American Enterprise Institute, said because Loeffler’s plan does not mention repealing the ACA, "the ACA's preexisting protections remain in place."
But Linda Blumberg, a fellow at the Urban Institute’s Health Policy Center, interpreted the plan differently. She said Loeffler’s plan "would make adequate, affordable insurance for people with problems far less accessible than it is under current law."
Blumberg and other experts pointed to two provisions in Loeffler’s plan in saying that it would provide less protection than the ACA.
One provision would "establish Guaranteed Coverage Plans to help cover patients with preexisting conditions." No details are provided, but guaranteed issue generally refers to requiring insurers to cover any applicant.
Before the ACA, such guaranteed coverage was sometimes provided through high-risk pools — non-group health coverage offered by states to customers who couldn’t otherwise obtain individual coverage. Such pools likely covered just a fraction of the people with preexisting conditions who lacked insurance, according to the nonpartisan Kaiser Family Foundation, and they charged far more than what a typical person would pay in the non-group market.
If the Guaranteed Coverage Plans provision in Loeffler’s plan is a high-risk pool, Larry Levitt, KFF’s executive vice president for health policy wrote, "it could provide help" if it’s adequately funded. But "the history of high-risk pools is that benefits were limited and premiums were high." Other experts also said Loeffler’s proposal appears to be proposing high-risk pools.
Health care consultant Robert Laszewski noted that Loeffler’s proposal has a specific plan for those who want their preexisting conditions covered, whereas all individual plans in the ACA’s exchanges cover preexisting conditions. Her Guaranteed Coverage Plans provision "would seem to indicate she will have a plan that does not cover preexisting conditions, but then she will offer a special plan that will," Laszewski said, alluding to high-risk plans that "tended to offer very limited and very expensive coverage."
Another provision in Loeffler’s plan would give low-income families with preexisting conditions a one-time federal tax credit toward Health Savings Account contributions.
The fact that people with preexisting conditions would need separate plans "sends a strong signal that they would no longer be guaranteed coverage or community rates in marketplace plans" as they are under the ACA, and "it seems likely that these plans would work like the high-risk pool plans," said law professor Wendy Netter Epstein, director of DePaul University’s Health Law Institute.
"If those with preexisting conditions will only be able to get plans with fewer benefits and higher costs," she added, "that explains why her proposal tries to help out low-income families with preexisting conditions with a one-time tax credit."
Such a credit "is like giving a family one bag of sand to protect their home as a hurricane rushes in," given that families with preexisting conditions can spend thousands of dollars more a year on medical care, said Allison Hoffman, a health care law expert at the University of Pennsylvania School of Law.
"There’s nothing substantive in Kelly Loeffler’s framework that would protect people with preexisting conditions anywhere near to the degree the Affordable Care Act does," Hoffman said.
Loeffler said her health care plan would "ensure Americans with preexisting conditions are protected."
The plan lacks any detail to explain how it would provide protections that are at least as strong as the Affordable Care Act. Two of the plan’s provisions indicate it would make adequate and affordable insurance less accessible for people with preexisting conditions, experts say.
Without evidence to back Loeffler’s claim, we rate it False.
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Sen. Kelly Loeffler, "The Modernizing Americans’ Health CarePlan," Nov. 13, 2020
Sen. Kelly Loeffler, news release, Nov. 13, 2020
PolitiFact, "Gardner’s bill has as much to do with politics as preexisting conditions," Sept. 18, 2020
PolitiFact, "Preexisting conditions — a cudgel Democrats are using to batter Republicans in the 2020 campaigns," Oct. 5, 2020
PolitiFact, "Georgia Sen. Perdue’s record on preexisting conditions doesn’t match his promises," Sept. 3, 2020
PolitiFact, "Claim that Ga. Sen. Kelly Loeffler backs ‘getting rid of health care’ partly correct," Nov. 20, 2020
Atlanta Journal-Constitution, "Loeffler releases new healthcare plans," Nov. 13, 2020
Twitter, tweets from Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, Nov. 13, 2020
Email, health care consultant Robert Laszewski, Health Policy and Strategy Associates, Nov. 24, 2020
Email, Jonathan Oberlander, a professor of health policy and management, and of political science, at the University of North Carolina, Nov. 24, 2020
Email, Joe Antos, health care scholar at the market-oriented American Enterprise Institute, Nov. 24, 2020
Email, Allison Hoffman, health care law expert and University of Pennsylvania School of Law professor, Nov. 24, 2020
Wendy Netter Epstein, professor of law and faculty director of the Mary and Michael Jaharis Health Law Institute at DePaul University, Nov. 24, 2020
Email, Raphael Warnock campaign communications director Terrence Clark, Nov. 24, 2020
Email, Linda Blumberg, fellow at the Urban Institute’s Health Policy Center, Nov. 24, 2020
Email, health care consultant Rodney Whitlock, who was the top health policy staff member for Republican congressional representatives, Nov. 24, 2020
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