Fact check on Gardner’s bill

Does senator’s proposal go far enough to protect preexisting conditions?

Sen. Cory Gardner, a Republican running in a tight race for reelection in Colorado, says he wants to protect people with medical conditions.

In a mid- September tweet released by his campaign, he promoted legislation he introduced in August that he says will do just that.

“People like my mother who battle chronic diseases are heroes,” read the tweet. “I authored the bill to guarantee coverage to people with pre- existing conditions — no matter what happens to Obamacare — because some things matter more than politics.”

Gardner has voted repeatedly to repeal the Affordable Care Act, the first federal law to guarantee coverage for people with preexisting conditions.

Polls show broad public support for keeping that provision while also indicating a consistent, if narrow, majority favoring the overall law.

The popularity of those protections has led Gardner, as well as other GOP candidates facing tough challengers, to swear their allegiance to protecting people with medical conditions, despite their records.

Gardner introduced The Pre-Existing Conditions Protection Act in August — legislation that has no co- sponsors and totals just 117 words.

The main section is a single, long sentence: “A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any pre- existing condition exclusion with respect to such plan or coverage, factor health status into premiums or charges, exclude benefits relating to pre- existing conditions from coverage, or otherwise exclude benefits, set limits, or increase charges based on any pre- existing condition or health status.”

A campaign spokesperson reiterated in an email that Gardner’s goal is “to guarantee coverage for individuals with preexisting conditions and ensure they cannot be charged more as a result of their underlying medical conditions.”

But Gardner’s bill isn’t enough, said Linda Blumberg, a fellow at the nonprofit Urban Institute’s Health Policy Center: “You need a package of policies working together in order to create real protections for people to have coverage to meet their health care needs.”

For instance, the bill does not explicitly bar insurers from outright rejecting applicants with medical conditions, something known as “guaranteed issue.”

Instead, the language may simply prohibit insurers from restricting services related to a medical condition only if they choose to sell an individual

insurance in the first place, said Thomas Miller, a resident fellow at the American Enterprise Institute.

Compare that with the ACA, which says every insurer selling individual or group coverage “must accept every employer and individual in the State that applies.”

Also needed in legislation aiming to protect people with medical problems, said Blumberg, are provisions for subsidies to help people of low and moderate income afford their premiums. The ACA has those.

Another way Gardner’s bill differs from the ACA is that it does not list benefits that must be included in a health insurance policy.

The ACA requires insurers to cover 10 broad categories of care, including hospitalization, prescription drugs, childbirth and mental health care.

“Without that, insurers could sell products that don’t cover very much, which is what we had prior to 2014,” Blumberg added.

So, wmat about costs?

Gardner’s legislation says insurers can’t “factor health status into premiums or charges.”

So insurers could not charge people more simply because they have diabetes, say, or cancer. Still, that leaves open a whole lot of other things that insurers could consider when setting premiums for individuals, such as such as gender or occupation, which could stand in as a proxy for health.

Douglas Holtz- Eakin, president of the American Action Forum, who wrote a blog post cited by the Gardner campaign, said the proposed legislation is a starting point.

If the ACA were to be struck down, Gardner would likely add provisions to it, he said.

Viewed in its most favorable light, Gardner’s proposal would only serve as a placeholder for larger legislation, upon which more protections would have to be layered.