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November 18, 2018

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Health exchange head says Heller bill gives illusion of protecting pre-existing conditions

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Yasmina Chavez

Heather Korbulic, executive director of the Silver State Health Insurance Exchange, is shown during an interview at the Las Vegas Sun office, Thursday, Oct. 2, 2017.

A Republican Senate bill that seeks to bolster protections for patients with pre-existing conditions falls short of current law, said Nevada’s health insurance exchange leader.

Nevada’s Republican Sen. Dean Heller is co-sponsoring a bill that requires coverage but not care for pre-existing conditions, said Heather Korbulic, executive director of the Silver State Health Insurance Exchange. These provisions of the Affordable Care Act are at risk under a federal lawsuit, and Democrats in Congress have introduced resolutions to allow House and Senate legal counsel to defend the law in court.

“It would have dramatic impacts on the whole country,” Korbulic said of the lawsuit. “We would go back to pre-ACA rules where you could again do medical underwriting based on pre-existing conditions — not everybody would be guaranteed a community rating, meaning they could have varied premium cost based on their health conditions, and many people would find themselves priced out of the market.”

Obamacare protects people with preexisting conditions in three ways, Korbulic said. It guarantees access to health insurance on the individual market, prohibits higher premiums for these patients, and requires coverage of essential health benefits, including mental health services and mental health and substance abuse treatment.

In Texas v. United States, the government is declining to defend the protections for premiums and essential health benefits provisions in the Affordable Care Act. A district court judge is expected rule on the case in early September, and Korbulic said it could make its way to the Supreme Court.

The Republican bill that Heller is co-sponsoring would prohibit denying coverage or charging higher premiums to patients based on their pre-existing conditions.

“Nevadans and Americans throughout the country with pre-existing conditions should be protected — period,” Heller said in a statement. “This legislation will make sure that Nevada’s most vulnerable have access to coverage, and I’m proud to join my colleagues to introduce it.”

Korbulic said she agrees with Larry Levitt, senior vice president of the Kaiser Family Foundation, who called the bill’s attempts to provide protections for these patients “something of a mirage” because the legislation does not retain a key ACA provision being challenged in court.

The lawsuit seeks to eliminate an ACA change to the Health Insurance Portability and Accountability Act that prevents excluding coverage for pre-existing conditions in health insurance plans, Korbulic said. The bill Heller is co-sponsoring fails to address that, which would be eliminated if the lawsuit is successful.

“For instance, if you have brain cancer, an insurance company cannot deny your application because you have brain cancer, but they can certainly say that they don’t cover that brain cancer treatment,” Korbulic said of the bill. “They would exclude that pre-existing condition from coverage.”

Before Obamacare became law, some states capped how long these exclusions could be in place, but Nevada was not one of them, according to the Kaiser Family Foundation. While the state has taken steps to codify some ACA provisions into state law, such as requiring coverage for mammograms and other types of preventive care, it essentially points to federal rules on what plans have to be made available, Korbulic said.

“If the federal regulations are gone, then that’s gone for us too,” Korbulic said.

Democrats joined Heller’s challenger for his Senate seat, Rep. Jacky Rosen, in introducing the House resolution calling for legal counsel intervention in the ACA lawsuit.

“Refusing to defend the existing law could take us back to the days when insurance companies could discriminate against people for everything from battling cancer to being pregnant,” Rosen said in a statement at the time.