On protecting people with pre-existing conditions, Jacobs' claim needs context

Republicans in races across the country, aware of polling data showing Americans care about keeping and affording their health insurance coverage regardless of pre-existing conditions, are talking about their efforts to keep these protections if the U.S. Supreme Court dismantles the Affordable Care Act. 

Democrat Nate McMurray, running in the 27th Congressional District, said the incumbent, Rep. Chris Jacobs, supports using U.S. Justice Department funds for a lawsuit challenging the ACA, also known as Obamacare. Jacobs' voting record supports this. The existing law contains strong protections for people with pre-existing conditions. The Supreme Court will hear arguments in the case on Nov. 10. 

Jacobs, a Republican, countered McMurray’s claim. 

"I am for protecting pre-existing conditions," he said during a debate at St. Joseph’s Collegiate Institute. "Actually, in the first couple of months I actually co-sponsored legislation to do just that." 

Protecting people with pre-existing conditions is a priority of the nearly three-quarters of Americans, according to a July 2019 poll. So we wondered about Jacobs’ claim. 

Jacobs co-sponsored the "Pre-existing Conditions Protection Act of 2019," on Sept. 30, about two months following his swearing-in on July 21. 

The bill, H.R. 692, was introduced on Jan. 18, 2019, by Rep. Greg Walden, R-Ore., but no other action has been taken on it. It has 83 co-sponsors, all Republicans.

Jacobs’ spokesperson, Cam Savage, told us the bill contains key provisions that protect patients, including prohibiting insurers from excluding certain benefits based on pre-existing conditions, prohibiting charging people with pre-existing conditions higher premiums, and guaranteeing that people will be issued policies. 

"This bill is one step in the process to improve health care for all Americans should the ACA be struck down by the Supreme Court," Savage said. 

In New York, there are protections for people with pre-existing conditions, regardless of whether the ACA is struck down by the high court. But without the federal law, states also face losing the federal subsidies that help pay for the coverage. New York state could face dire financial consequences, including the loss of $3.7 billion for the state and nearly $600 million for counties, according to a state report from 2017. In addition, the state estimated that 2.7 million New Yorkers would lose coverage.

We reached out to KFF, formerly the Kaiser Family Foundation, a neutral source of information about health policy. 

The bill contains some of the protections contained in the ACA, but not all of them, said senior fellow Karen Pollitz. 

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Pollitz confirmed the bill forbids insurers from selling policies that lack certain coverage based on a customer’s pre-existing conditions. It also prevents insurers from turning patients down if they apply for coverage, known as guaranteed issue. The bill’s provision on whether groups of insured people could be charged more if someone in the group is sick contains the wrong language, Pollitz said, though she thinks that it was a mistake and not intentional. 

Though the bill contains those provisions, Pollitz said people with pre-existing conditions could still face barriers to coverage based on how the insurance market behaved before the ACA.

"There is a history with all of this," Pollitz said. "This isn’t theoretical." 

The bill does not require policies to contain certain benefit standards, she said. Some policies could omit coverage for major medical services, such as chemotherapy or maternity care.  

Healthy people would purchase these cheaper plans, leaving sicker people to pay for costly plans that contain pools of mostly sick people. 

The bill also doesn’t prohibit lifetime limits, so patients with costly medical conditions could reach the end of their insurance coverage while they still need it. 

Other protections, such as prohibitions on discriminating based on gender, age, and out-of-pocket caps aren’t in this GOP House bill, she said. The subsidies, or funds that allow people to purchase plans for lower costs, are not in the bill either. 

Based on all of this, those people with expensive health conditions probably couldn’t purchase insurance for an affordable premium on the individual market, she said. 

The Center for Budget and Policy Priorities, which focuses on policy effects on people with low incomes, came to the same conclusion in its analysis. 

"Eliminating the ACA’s financial assistance would put coverage out of reach for millions of low- and moderate-income consumers, including many with pre-existing conditions," wrote Sarah Lueck, a senior policy analyst. "It also would create severe adverse selection in state insurance markets, since it would remove a major financial incentive for healthy people to enroll in plans that pool risk across people with and without serious health needs."

Jacobs said he co-sponsored legislation to protect people with pre-existing conditions. 

He did co-sponsor a bill that protects people with pre-existing conditions in certain respects. But experts said that to truly ensure that people with pre-existing conditions can access coverage, more comprehensive action is needed. If the ACA is repealed or struck down and this legislation is put in its place, people with pre-existing conditions could find the coverage they need to be unaffordable, they said. 

So while his statement is accurate, it needs clarification.

We rate Jacobs’ claim Mostly True.