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H.R. 986: Protecting Americans with Preexisting Conditions Act of 2019

May 9, 2019 at 6:34 p.m. ET. On Passage of the Bill in the House.

This was a vote to pass H.R. 986 in the House.

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

Context

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 HealthCare.gov 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.

Totals

All Votes D R
Aye 56%
 
 
230
226
 
4
 
No 44%
 
 
183
0
 
183
 
Present
 
 
1
0
 
1
 
Not Voting
 
 
17
8
 
9
 

Passed. Simple Majority Required. Source: house.gov.

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Study Guide

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You can find answers to most of the questions below here on the vote page. For a guide to understanding the bill this vote was about, see here.

What was the procedure for this vote?

  1. What was this vote on?
  2. Not all votes are meant to pass legislation. In the Senate some votes are not about legislation at all, since the Senate must vote to confirm presidential nominations to certain federal positions.

    This vote is related to a bill. However, that doesn’t necessarily tell you what it is about. Congress makes many decisions in the process of passing legislation, such as on the procedures for debating the bill, whether to change the bill before voting on passage, and even whether to vote on passage at all.

    You can learn more about the various motions used in Congress at EveryCRSReport.com. If you aren’t sure what the House was voting on, try seeing if it’s on this list.

  3. What is the next step after this vote?
  4. Take a look at where this bill is in the legislative process. What might come next? Keep in mind what this specific vote was on, and the context of the bill. Will there be amendments? Will the other chamber of Congress vote on it, or let it die?

    For this question it may help to briefly examine the bill itself.

What is your analysis of this vote?

  1. What trends do you see in this vote?
  2. Members of Congress side together for many reasons beside being in the same political party, especially so for less prominent legislation or legislation specific to a certain region. What might have determined how the roll call came out in this case? Does it look like Members of Congress voted based on party, geography, or some other reason?

    One tool that will be helpful in answering this question is the cartogram at the top of the page. A cartogram is a stylized map of the United States that shows each district as an identical hexagon. This view allows you to see the how the representatives from each district voted arranged by their geography and colored by their political party. What trends can you see in the cartogram for this vote?

  3. How did your representative vote?
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