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Pre-existing conditions coverage weakens in bill passed for post-Obamacare Florida

The bill requires insurers cover pre-existing conditions if the Affordable Care Act vanishes, but doesn’t have requirements that are in the current law to control prices and stop insurers from charging higher rates
“We must engage the consumer so that market forces can apply.” -- Florida House Speaker José Oliva

SCOTT KEELER   |   Times
“We must engage the consumer so that market forces can apply.” -- Florida House Speaker José Oliva SCOTT KEELER | Times
Published May 2, 2019
Updated May 2, 2019

TALLAHASSEE -- Florida lawmakers approved a health insurance bill Wednesday that would require insurers keep covering pre-existing conditions if the Affordable Care Act disappears, though the bill would not keep protections in the federal law to control how much those patients can be charged.

The bill, Senate Bill 322, which the House approved by a 70-42 vote after the Senate passed it last week, would also expand short-term and association health plans and change requirements for “essential health benefits” covered by insurers, regardless of the status of the Affordable Care Act. It must be approved again by the Senate before it heads to Gov. Ron DeSantis for his signature.

The bill originally started as a proposal that would just require insurers and organizations that manage healthcare to offer at least one policy offering coverage regardless of a pre-existing condition. It also stipulated that the requirement would only go into effect if the federal law was repealed or struck down in court.

But the state Senate last week substantially amended the bill to tie it to the two other healthcare bills moving through the process as priorities of House Speaker José Oliva.

Advocates for the amended bill said if the Affordable Care Act, better known as “Obamacare,” is somehow repealed by Congress or overturned by the U.S. Supreme Court, the bill will make sure those with pre-existing conditions will remain protected. Hundreds of thousands of patients in Florida have such pre-existing conditions.

The legislation “makes healthcare more affordable and provides a safety net,” House sponsor Rep. Tommy Gregory, R-Sarasota, said.

But critics said the bill doesn’t have requirements that are in the Affordable Care Act to control prices on such plans and stop insurers from charging higher rates, and that changing the requirements for essential health benefits would weaken coverage. They also contended that the short-term and association health plans authorized by the bill don’t provide enough coverage and could siphon away healthy people with cheaper rates. That, they added, would increase the number of sicker people on other plans and cause premiums to rise.

“What we’re really trying to do here is create two markets. We’re going to create the one market which is a lot cheaper, pay less and pray you stay healthy,” said Rep. Nick Duran, D-Miami, on Wednesday. “The other one: pay through the nose. If you’re sick, if you have a pre-existing condition, well my gosh, you’re going to have to find a way to finance that plan because now you’re not going to be able to find those plans there.”

The legislation mirrors a federal push to also retain coverage of pre-existing conditions — though it has also been criticized as rolling back some protections — in the event a repeal of the Affordable Care Act is revived. In addition to barring insurers from charging more for pre-existing conditions, the Affordable Care Act also explicitly bars insurers from charging patients more because of their sex or putting yearly or lifetime limits on what the insurer will spend on required coverage.

The state legislation includes a provision that would bar insurers from restricting benefits.

“Don’t buy the hype,” warned Sen. José Javier Rodríguez, D-Miami, when the bill was heard in the Senate last week. He added the Affordable Care Act “set a baseline to make sure…that persons with pre-existing conditions are not left out in the cold.” This bill “effectively chips away at the existing protections we have.”

“When you increase the numbers of uninsureds, all you do is send people to the emergency room, which is extremely expensive,” he added. “In the long run, this is going to put us in a more vulnerable position.”

But Sen. Wilton Simpson, R-Trilby, who sponsored the bill in that chamber, said the bill was a multi-pronged solution to high medical costs that would also enable small businesses to be more competitive.

“This bill is comprehensive in nature,” Simpson told lawmakers on the floor. “We’re going to cover pre-existing conditions. We’re going to cover more competitive healthcare plans.”