Haley Stevens’ ad gets details on ACA repeal wrong

Rep. Haley Stevens, D-Mich., seeking re-election in Michigan’s traditionally Republican 11th congressional district, is attacking her challenger, Eric Esshaki, over how his opposition to the Affordable Care Act would affect Michiganders hit by COVID-19.

"Esshaki supports a dangerous health care plan that would allow insurance companies to kick people with a preexisting condition off their plans in the middle of a pandemic, including over 100,000 Michiganders who have survived COVID-19," a Stevens ad claims.

What is the purportedly "dangerous healthcare plan" that Esshaki supports?

Like many Republicans, Esshaki, a former nurse and lawyer, has vowed to support fully repealing the Affordable Care Act, or Obamacare, which bars insurance companies from discriminating against people with a preexisting health condition in both enrollment and pricing. The law is now facing a Supreme Court challenge backed by the Trump administration, and Democrats running for Congress this fall have hammered Republicans over the potential threat to those protections in the midst of the coronavirus pandemic and ensuing economic recession.

Stevens’ ad predicts that if the ACA is repealed by Congress or overturned by the Supreme Court, insurance companies would be free to designate coronavirus infections as a preexisting condition and restrict or deny coverage for those infected.

But Stevens’ claim exaggerates the potential impact by citing the roughly 100,000 Michiganders who have survived COVID-19, because not all of them have insurance through the individual market. Most people who are currently covered by job-based programs, or through Medicaid or Medicare, for example, would not be at risk of suddenly losing their coverage if insurers designate COVID-19 a preexisting condition.

A different story would play out for Michiganders who may lose or change jobs amid the recession if the ACA is repealed or overturned. They could be subject to discrimination based on a preexisting condition in the individual insurance market or temporarily excluded from a job-based group plan.   

In 2018, 51% of Michiganders were insured through their employer, 22% through Medicaid, 15% through Medicare and 5% through individual insurance plans, according to the nonpartisan Kaiser Family Foundation.

For years, Republicans have promised to replace the ACA with a law that maintains protections for individuals with preexisting conditions, but a plan that guarantees the same level of protection has never materialized. The ACA’s original protections were made possible by a complex system of mandates and subsidies designed to stabilize the individual insurance market.

"In a voluntary insurance market that is not subsidized, there is a powerful and innate need for insurers to avoid the highest-cost people," says Karen Pollitz, a senior fellow at the Kaiser Family Foundation. "There’s always this powerful incentive to compete on the basis of cherry-picking."

Ahead of the August primary, Essahki committed to waiting to repeal the law until one that protects coverage of preexisting conditions is enacted and said he opposes Republican efforts to repeal the ACA without a replacement. In an email to PolitiFact Michigan, Esshaki called Stevens a "scaremonger" who "fabricates attacks."

Stevens’ campaign called Esshaki one in a "long line of Washington Republicans who promise to conjure up a brand new plan to protect people with preexisting conditions, even though we all know the new plan is never coming."

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President Donald Trump has not presented a Republican-backed health plan, despite repeated promises to do so. Republicans in the current Congress have also been unable to come together behind a major plan. Esshaki has not endorsed any specific replacement plan or released a detailed vision for an alternative. 

The ACA prohibits health insurers from denying coverage to people with a preexisting condition or charging them more. Stevens predicts that with the ACA gone, insurers would designate coronavirus infection as a preexisting condition and restrict coverage accordingly.

That could happen unless states act to protect those infected with coronavirus from discrimination, but it wouldn’t mean every Michigander who has survived COVID-19 would be kicked off their plans as Stevens claims.

The most recent data shows just under 100,000 people in Michigan have recovered from COVID-19. These people are likely covered through a variety of health insurance plans: insurance they purchased through the individual marketplace, job-based group health plans, Medicaid and Medicare. Repealing the ACA would affect each of these groups differently, but it’s the people in the individual market whose coverage is most at risk.

Before the ACA was enacted, insurers in the individual market regularly discriminated against people with preexisting conditions, such as arthritis, asthma, high cholesterol, obesity and diabetes. That discrimination could resume if the ACA were repealed or overturned without an equivalent replacement. If COVID-19 is designated a preexisting condition, infected people could be denied coverage or charged higher premiums in the individual market.

But people already insured through a job-based group health plan wouldn’t be affected the same way, because they had some protections under federal law even before the ACA.

Before the ACA, the Health Insurance Portability and Accountability Act required insurers selling policies in the group market to cover everyone regardless of a group member’s health status. While people currently insured through a job-based group health plan would not be kicked off their plans, new employees enrolling in a job-based program could be denied coverage if the ACA’s strengthened protections are taken away.

Under HIPAA, people newly enrolling in a job-based group health plan could be denied coverage for up to a year if they had a preexisting condition that was diagnosed or treated in the previous six months.  

That means that a new enrollee in a job-based group health plan who has tested positive for COVID-19 in the last six months could be denied coverage for up to a year, according to a new report from the Kaiser Family Foundation.

Medicare, the federal health insurance program for seniors, and Medicaid, the federal- and state-funded plan for low-income people, do not discriminate on the basis of preexisting conditions in coverage or price. However, if the ACA is repealed or overturned, adults who have gained Medicaid coverage through the program’s expansion under the ACA could lose coverage and be forced to turn to the individual market, where they would be subject to discrimination based on preexisting conditions.

A Haley Stevens campaign ad says her challenger, Eric Esshaki, supports a plan that would allow insurers to kick over 100,000 COVID-19 survivors in Michigan off their health care plans.

Stevens cites Esshaki’s support for repealing the Affordable Care Act, which includes protections for preexisting conditions. But Esshaki has called for waiting to repeal the ACA until there’s a replacement that maintains those protections.

Stevens’ ad also assumes that all Michiganders who have survived COVID-19 would be affected in the same way — and lose their coverage — if the ACA were repealed or overturned. That’s not the case. People in the individual insurance market would be most at risk if insurers designate coronavirus infections as a preexisting condition. But the effect on people covered by job-based group plans, Medicare or Medicaid would be more limited.

The claim contains an element of truth but ignores critical facts. We rate it Mostly False.