Making A Prohibition On Preexisting Condition Exclusions Effective Requires Additional Measures

One of the most popular components of the Affordable Care Act (ACA) is the prohibition on preexisting condition exclusions, eliminating the practice in which insurers exclude coverage for health problems that people had prior to enrolling in an insurance plan. People do not like the idea that an insurer does not have to pay for care that people need due to a previously known health problem. But prohibitions on preexisting condition exclusions alone are insufficient to protect those with health problems and ensure their affordable access to necessary care. Meaningful protections require a package of policies: guaranteed issue of all insurance products, essential health benefit requirements, modified community rating, cost-sharing standards, plus prohibitions on preexisting condition exclusions. Policy proposals that maintain the prohibition on preexisting condition exclusions without the other protections are providing an empty promise to those with health problems and those who may suffer a health problem in the future. Why is that? Let’s take each policy in turn. Guaranteed Issue Of All Products If insurers can deny coverage outright based on the health status or expected health status of the applicant, then coverage for preexisting conditions are not guaranteed, because someone with a health problem may not even be able to buy insurance, regardless of the price. If only certain products are guaranteed issue, the limited options in which people with health problems can enr...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Following the ACA Insurance and Coverage Quality ACA repeal and replace American Health Care Act community rating Essential Health Benefits preexisting conditions Source Type: blogs