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H.R. 986 (116th): Protecting Americans with Preexisting Conditions Act of 2019

Would a House-passed bill lower costs and allow flexibility, or potentially exclude Americans with preexisting conditions?


Since 2010’s Affordable Care Act, popularly called Obamacare, health insurance companies can no longer refuse a customer healthcare because of a preexisting condition. Pew Research Center found that even 63% of Republicans support that provision.

A portion of the law known as Section 1332 allowed states to experiment with health care requirements and programs within their borders. But these state variations needed to receive approval through waivers from the federal government.

The Obama Administration released guidance in 2015, through the Department of Health and Human Services, about which types of state variations were likely (and not likely) to gain federal approval. However, many criticized the guidance for being too rigid.

Under the Trump Administration, far more lenient new guidance was released in October 2018. It announced that the administration would permit a far greater level of state variation and experimentation on healthcare. Some fear this could allow for more so-called “junk plans,” including short-term health plans or association health plans, which are exempt from Obamacare rules and could exclude coverage for preexisting conditions.

What the legislation does

The Protecting Americans with Preexisting Conditions Act would formally repeal the Trump Administration’s October guidance, halting the state-led expansion of health insurance plans which could discriminate or exclude coverage based on preexisting conditions.

It was introduced in the House on February 9 as bill number H.R. 986, by Rep. Ann Custer (D-NH2). It was introduced in the Senate a few days later on February 13 as bill number S. 466, by Sen. Mark Warner (D-VA).

What supporters say

Supporters argue the legislation safeguards a person’s health care, even if they have a medical ailment which they were born with or cannot control.

“We cannot go back to a time when Americans with preexisting conditions can be charged more or denied care,” lead House sponsor Rep. Kuster said in a press release. “Our legislation provides much-needed pushback against the Trump Administration’s repeated and ongoing sabotage of the Affordable Care Act and our healthcare system.”

“Junk plans will increase health care costs for millions of consumers while weakening protections for individuals with pre-existing conditions,” Senate lead sponsor Sen. Warner said in a press release. “The Trump Administration should stop trying to undermine the success of the Affordable Care Act, and instead work with Congress on targeted, bipartisan fixes that will lower health care costs and expand access to comprehensive, affordable health care coverage.”

What opponents say

Opponents counter that expanding the availability of short-term and association health care plans would allow consumers more options and provide lower costs. (Plans which have to cover less generally cost less, too.)

“The Patient Protection and Affordable Care Act, however, has severely limited the choice of healthcare options available to many Americans and has produced large premium increases in many State individual markets for health insurance,” the White House wrote in a 2017 executive orderannouncing a partial expansion of such short-term and association health care plans. “The average exchange premium in the 39 states that are using in 2017 is more than double the average overall individual market premium recorded in 2013.”

“My Administration will also continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout the healthcare system,” the executive order continued. “To the extent consistent with law, government rules and guidelines affecting the United States healthcare system should: expand the availability of and access to alternatives to expensive, mandate-laden [Obamacare] insurance, including association health plans, short-term / limited-duration insurance, and health reimbursement arrangements.”

Odds of passage

The bill passed the House on May 9 by 230–183, or 55.6%.

All voting Democrats were in favor. All but four voting Republicans opposed: Reps. Brian Fitzpatrick (R-PA1), John Katko (R-NY24), Jim Sensenbrenner (R-WI5), and Chris Smith (R-NJ4).

The Republican-controlled Senate seems likely to vote it down, if Senate Majority Leader Mitch McConnell (R-KY) even allows it to come up for a vote in the chamber at all. Then again, McConnell has also said he’s in favor of keeping protections for preexisting conditions.

Last updated Jun 12, 2019. View all GovTrack summaries.

The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on May 9, 2019.

Protecting Americans with Preexisting Conditions Act of 2019

(Sec. 3) This bill nullifies guidance from the Department of the Treasury and the Department of Health and Human Services titled State Relief and Empowerment Waivers, published on October 24, 2018. The guidance pertains to Section 1332 waivers (also known as State Innovation Waivers or State Relief and Empowerment Waivers), which allow states to forego certain requirements of the Patient Protection and Affordable Care Act in order to implement experimental plans for health care coverage, as long as the resulting coverage meets certain statutory criteria.

The guidance, which supersedes earlier guidance from 2015, alters agency interpretation of how states may satisfy the statutory criteria for waiver approval. For example, the guidance (1) redefines acceptable coverage under such waivers to include short-term, limited-duration insurance and association health plans; (2) allows the comprehensiveness and affordability of coverage under such waivers to be assessed based on projected availability, rather than enrollment; and (3) allows the level of coverage to be assessed based on the effects over the entire course of the waiver, rather than per year.

(Sec. 4) The Government Accountability Office must report on the number of individuals that would have been expected to lose access to health insurance coverage, as well as the expected effect on mental health care treatment, in the absence of this bill.