Health Coverage at Work? Lawsuit Against ACA Could Affect You, Too


Millions of people who get health insurance through their job could face waiting periods for coverage or find that specific medical conditions aren't immediately covered if the courts back a request by the Trump administration to toss key provisions of the ACA (The provisions targeted by the Justice Department include the bans on insurers denying coverage and charging higher rates to people with pre-existing health conditions. The department also seeks to roll back limits on how much insurers can charge people based on gender and age.)

Most of the attention surrounding a recent Justice Department request to strike down parts of the ACA (see Four Ways Below) focuses on the individual market, where people buy their own coverage. But the request would also rewind some protections for the vast majority of Americans—some 175 million people—who get health coverage via small and large employers, analysts said.

The Justice Department last week filed a brief in a continuing lawsuit filed in February seeking to strike down the ACA. The department largely supported the lawsuit, which argues that the ACA law is invalid since its penalty on people who don't get insurance was repealed late last year as part of the Republican tax plan.In May, the administration asked the court to halt the ACA's guarantee of coverage for people with pre-existing health conditions (A push to make it easier for insurers to sell across state lines could further erode protections for people with pre-existing conditions, some health analysts said.Insurers would be able to sell policies in all states that conform only with the insurance regulations in the state where they say they are based. Many would likely obtain licenses in states with the most lax insurance regulation.) and to relax limits on how much insurers can charge older people and women.

The ACA established consumer protections in the individual insurance market, but also enacted protections in employer-provided coverage, especially for smaller companies.

If the courts toss some ACA provisions linked to the insurance-coverage mandate, elements of the requirements that also apply to employer plans would likely be halted or reversed as well, analysts report. In these cases, the provisions would likely revert to the Health Insurance Portability and Accountability Act of 1996.Meaning that employers would again be able to impose lengthy waiting periods for health coverage on new hires. Currently they are unable to lock workers out of health insurance for longer than 90 days when they take a new job.

Employers could also opt not to cover a new hire's specific health problem, like cancer, for up to a year even if they provide them insurance. That limit would apply if a new hire hadn't previously had coverage or had let it lapse.And, when smaller companies shop for insurance, they could be charged more to cover their workers if they have a large number of older or sicker people. That can indirectly lead to higher costs for workers who pay a share of their premiums, health analysts said. Those with healthier and younger employees may be charged less.

More than 13 million people get coverage through small employers.The ACA requires that insurers and many employers provide certain basic benefits to consumers, as well as requiring that all Americans have insurance, in an effort to draw younger, healthier people into the insurance pool. Conservatives have long criticized these requirements.

The Supreme Court 2012 landmark opinion that the health law, and specifically the requirement that Americans have health insurance, was constitutional because the penalty for not having coverage was handled by the Internal Revenue Service and fell within Congress's taxation powers.In joining the recent lawsuit, the Attorney General said that with the individual mandate now repealed, the law was no longer constitutional.

The implications aren't as big as for the individual market, but they're real said one insurer.

Four Ways

Options In 2019: In the short term, some health-insurance markets could see fewer options if companies react to renewed uncertainty by leaving the marketplace. In some cases, state insurance regulators to ensure viable markets. Roughly one-quarter of consumers in the individual insurance markets have only one company selling coverage, according to recent data.Company exits could leave consumers with no options, though last year new entrants emerged to sell coverage.

Rates In 2019: Many insurers are already seeking double-digit increases in premiums for 2019. ACA premiums are expected to rise 15% next year, on average, largely because last year's tax law that eliminated the health law's penalty for the uninsured. The ACA's backers argue that allows healthier people opt out of coverage.Insurers could seek further increases as a way to buffer their operations against the latest uncertainty over the health law.Consumers eligible for ACA subsidies will see that financial assistance rise with premiums, but not all shoppers in the marketplace qualify for subsidies.

Lower Premiums For Some In 2019: If the courts invalidate the requirements on covering people with pre-existing conditions, healthy consumers likely would see cheaper insurance. Their premiums would no longer be an average market rate that ensures those with pre-existing conditions pay the same premiums but could reflect the likelihood that healthy consumers would require less-expensive care.Young, healthy buyers have already seen their options increased by other moves taken by the administration to allow plans that offer limited coverage for a lower price.

Expensive / Hard-to-get Coverage For Some In 2019: People with pre-existing conditions could find that they are no longer eligible to get coverage, should insurers return to practices followed before the health law of charging more to such consumers or refusing to insure them.

Source: WSJ

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Sunday, 24 March 2019