New Resources Arm Advocates with Tools to Defend Essential Health Benefits, Pre-Existing Condition Protections

On July 9, the Fifth Circuit Court of Appeals heard oral arguments in Texas v. United States, the court case challenging the Affordable Care Act’s (ACA) constitutionality. A federal judge and the U.S Department of Justice have sided with the plaintiffs, declaring that the ACA is unconstitutional. The litigation is ongoing, but if the plaintiffs prevail, the law could be overturned in its entirety.

Some of the most critical provisions of the ACA are pre-existing condition protections and the Essential Health Benefits (EHB). The law’s pre-existing condition protections, such as the requirement to issue coverage to everyone regardless of health status, help prevent insurers from discriminating against sick people. The EHB are a minimum set of health services that all non-grandfathered individual and small group plans must cover, a standard that protects access to comprehensive, affordable insurance and prevents insurers from “cherry picking” healthy enrollees through benefit design.

With the federal court case looming, state policymakers and advocates are looking for ways to preserve access to coverage in the absence of the ACA’s protections. One option is to codify the law’s key provisions into state law. To aid in these efforts, Community Catalyst has teamed up with CHIR experts to create two new guides for its health insurance reform toolkit: The Advocate’s Guide to Pre-Existing Condition Protections and The Advocate’s Guide to Essential Health Benefits. With the help of these guides, stakeholders can evaluate options in their state for protecting some of the most vulnerable residents, including the intricacies and tradeoffs of adopting the ACA’s policies at the state level. Both of the new guides provide background on the ACA’s policies and discuss important considerations for state officials and advocates.

You can access the whole health insurance reform toolkit here, read the guide for pre-existing condition protections here, and read the EHB guide here.

One thought on “New Resources Arm Advocates with Tools to Defend Essential Health Benefits, Pre-Existing Condition Protections

  1. This is wonderful. I belong to a women’s Indivisible group in Long Beach and keep the group abreast on health insurance issues. This will be very helpful. While not at all crucial to the sense of the guide, you might find it interesting to know that, before the ACA, when a preexisting condition was not covered under a policy, some insurers attempted to connect a number of claims to the excluded preexisting condition. One instance I recall was denial of a claim for services related to headaches when the preexisting condition was a history of breast cancer. I once attempted to get legislators to require a list of related conditions to be excluded when selling a policy a preexisting condition exclusion. The insurers argued they couldn’t possibly identify related conditions beforehand, yet they had no trouble identifying them when they wanted to deny claims. I can see that happening again if the Texas case is lost. Thanks again, for this guide.

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