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H.R.986 - Protecting Americans with Preexisting Conditions Act

The House passed H.R.986 (230-183), which revokes the guidance issued by the Health and Human Services (HHS) and Treasury departments on Oct. 24, 2018, that revised the criteria for Section 1332 waivers under the 2010 health care overhaul by prohibiting the two departments from taking any action to implement or enforce that guidance (under which short-term, limited-duration insurance could be offered that does not have to comply with ACA patient protection requirements, such as protections for individuals with preexisting conditions).

It also prevents HHS and the Treasury from issuing any substantially similar guidance or regulation in the future.


Supporters of the bill, primarily Democrats, say it is crucial to prevent the Trump administration from undermining the ACA's patient protections, in particular protections for people with preexisting medical conditions. Republicans claim they support protections for such individuals, but Democrats argue they continue to support and propose policies that would circumvent those protections — including by promoting short-term health insurance policies that are exempt from the ACA's patient protections — as the new Section 1332 guidance does. Promoting short-term plans that don't cover preexisting conditions or include other patient protections also weakens state ACA insurance exchanges by encouraging younger, healthier people to leave the ACA risk pool, which bill supporters say increases the cost of ACA-compliant health care insurance for those requiring more comprehensive coverage. Section 1332 of the ACA clearly directs states to maintain minimum benefits and comprehensive, affordable health care coverage for state residents; the administration's misguided guidance should be immediately revoked.


Opponents of the bill, primarily Republicans, say the administration's revised guidance will encourage more states to experiment with health insurance reforms and help make affordable health insurance available to more Americans. The original Section 1332 waiver process was far too cumbersome, they say, while the updated guidance loosens restrictions that limited state flexibility and consumer choice in health plans. Making a wider variety of insurance available to Americans will dramatically increase the number of Americans with health insurance, they say, as individuals are able to choose affordable policies that suit their needs. To date, the handful of states that have implemented changes under 1332 waivers have seen positive results; by making it easier for states to get waivers, the administration's guidance will expand that benefit. Republicans say they do support protections for persons with preexisting conditions, and that the bill will do little to actually protect such individuals. Democrats need to join Republicans in seeking solutions outside of the unworkable and unaffordable ACA framework.

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