Insurers could charge huge premiums under Yoder-backed bill, health care experts say

Rep. Kevin Yoder
Rep. Kevin Yoder AP

Rep. Kevin Yoder and other top House Republicans say they’re committed to protecting people with pre-existing conditions — but their big push to change current law could actually mean ballooning insurance bills for people with chronic illness, health experts say.

Republicans are struggling to defuse controversy about their plans to dramatically change the Affordable Care Act, also known as Obamacare. Polls show that ending the law’s strong protections for people with pre-existing conditions is political poison for GOP candidates.

Yoder, R-Kansas, signed onto the Pre-existing Conditions Protection Act earlier this month, a week after oral arguments began in Texas for a GOP lawsuit to repeal Obamacare.

If successful, the lawsuit could also eliminate the law’s popular provision that bars insurers from denying health coverage for pre-existing conditions. Kansas is one of 20 GOP-led states that signed onto the suit.

Yoder’s antidote, though, is fraught with problems, independent experts agreed.

“They have to cover you, they can’t exclude coverage of your pre-existing condition or deny you coverage, but they can charge you a million a month, they can charge you a deterrent premium,” said Karen Pollitz, senior fellow at Kaiser Health Family Foundation.

The bill’s author, Rep. Greg Walden, R-Oregon, rejects that interpretation. His spokesman Zach Hunter said it wasn’t the legislation’s intent. Yoder’s office noted that he’s long been committed to finding a way to maintain protections for people with pre-existing conditions such as asthma, cancer and diabetes.

“Kevin’s position is and always has been that we must keep the protections for those with pre-existing conditions in the law, and he will continue to work with Republicans and Democrats to ensure those protections remain strong regardless of the outcome of the ongoing lawsuit,” said CJ Grover, Yoder’s spokesman, in a statement.

As Democrats pound vulnerable Republican incumbents such as Yoder with ads accusing them of trying to rip voters’ health coverage away, he and other GOP lawmakers from the states pushing the lawsuit have been scrambling for ways to preserve the protections.

Yoder is locked in a tight race with Democrat Sharice Davids in a suburban Kansas City district that Hillary Clinton narrowly won in 2016.

Walden’s bill had been introduced more than a year and a half before Yoder signed on as one of 78 co-sponsors. Yoder’s office issued a press release pointing to his co-sponsorship of the legislation as evidence that he “leads on protections for pre-existing conditions.”

America’s Health Insurance Plans, a group that represents the health insurance industry, said it wants to preserve the protection for pre-existing conditions in the current law, but it offered no position on the GOP bill.

The bill states that no health insurers can exclude a person’s pre-existing condition from coverage plans or turn someone down when he or she applies because of a pre-existing condition. It also prevents insurers from charging participants within a group plan more or less based on their health status.

But Pollitz and three other health care experts who reviewed the legislation for McClatchy say that the bill includes imprecise language that could allow insurers to charge individuals or employers whatever they want to cover pre-existing conditions — potentially putting the cost of premiums out of reach for individuals and small employers.

Experts from Washington and Lee University School of Law, Georgetown’s Health Policy Institute and a Kaiser Family Foundation vice president had similar readings of the bill.

The experts said it wasn’t clear to them if this apparent loophole that could trigger the higher costs — the use of the word “employers” instead of “employees” in a single sentence — was intentional or caused by awkward drafting.

Walden, who authored the bill, disputed this interpretation of its language. Walden chairs the House Energy and Commerce Committee, which helps write health care legislation.

“Chairman Walden introduced (this bill) to ensure patients with pre-existing conditions could sleep soundly knowing that the current protections they have would remain throughout various policy debates over the future of our healthcare system,” said Zach Hunter, a spokesman for Walden’s committee.

“In no way should this bill be read to do anything other than act as a guarantee of current pre-existing conditions protections,” Hunter said. “Any analysis suggesting otherwise is ignoring the plain legislative intent of the language itself and the clear message Chairman Walden has sent about explicitly maintaining these protections.

“Chairman Walden supports maintaining the current robust protections for patients with pre-existing conditions, and that’s exactly what H.R. 1121 would do. Period,” Hunter said.

Depending on future developments in health care policy, Walden would modify the bill as necessary to ensure patients with pre-existing conditions maintain protections, Hunter said.

The experts who had reviewed the legislation said that while they couldn’t speak to the author’s intent, they stood by their view of the bill’s language.

Timothy Jost, emeritus professor at Washington and Lee University School of Law and expert on health care policy, called Walden’s defense of his bill a smokescreen.

“There is a larger point worth noting here — you can’t just wave your hands and recite a magic formula and make pre-existing condition discrimination disappear even if you are a competent legislative drafter,” Jost said.

The incentives for insurers to discriminate in one way or another are just too great, he said.

“If they can’t explicitly discriminate based on health status, they will do so based on age, gender, duration of coverage, occupation, or in some other factor that serves to disadvantage people with pre-existing conditions,” Jost said.

Even if Republicans rewrote the bill to fix the awkward language on health status, other problems remain, he said.

As it stands, the bill would allow insurers to charge women more than men, and to charge older people 10 times as much as younger people, he said.

It would not prohibit insurance companies from setting lifetime limits on the dollar amount they spend on your care for essential health services, such as doctor and hospital visits, prescription drug coverage and mental health treatment.

Nor would it include federal subsidies to help people afford health care plans, as does Obamacare.

“This bill plugs a couple of holes, but if it doesn’t plug all of them, people with health problems are going to find themselves with unaffordable policies, policies that don’t cover what they need, or both,” said Sabrina Corlette, research professor at Georgetown University’s Health Policy Institute.

Yoder also has said he supports a resolution introduced by 28 House Republicans that would express “the sense of the House of Representatives” that pre-existing conditions should be retained in law even if Obamacare is amended or repealed.

The resolution, however, has no force of law.

“The resolution does absolutely nothing,’” Jost said.

Yoder’s co-sponsorship of the pre-existing conditions bill and his endorsement of the symbolic resolution do not impress health care advocates in Kansas, who noted the Overland Park Republican has repeatedly voted to repeal the Affordable Care Act.

“This is nothing but window dressing that attempts to make the public believe that he’s protecting their right to pre-existing conditions,” said Sheldon Weisgrau, the director of the Health Reform Resource Project, a Topeka-based non-profit that advocates for greater health care access.

Gayle Taylor-Ford, a 51-year-old resident of Overland Park in Yoder’s district, said the issue of pre-existing conditions is a deal-breaker for her this election.

“He (Yoder) says the right things, but how is he voting?” said Taylor-Ford, who owns a business that provides substance abuse treatment. She said she visited Yoder’s Washington office in March to voice her support for the Affordable Care Act.

Taylor-Ford, a registered Democrat, suffers from Temporomandibular Joint Disorder and purchases her insurance through the federal exchange. Her Republican husband, who has Multiple Sclerosis, is covered by Medicare, she said.

Both plan to vote for Davids in November, Taylor-Ford said.

Meg Godderz, a 41-year-old Overland Park resident with multiple sclerosis, said that she’s still weighing whether to support Yoder or his Democratic opponent, and the health care issue will be a huge piece of that decision.

Godderz, a registered Republican who is insured through her husband’s employer, said she’s watching the Obamacare lawsuit closely.

“It’s very scary. What does this mean for people who have pre-existing conditions?” she said. “... I don’t have the answer to that. I don’t think anybody does.”

Lindsay Wise: 202-383-6007, @lindsaywise
Bryan Lowry: 202-383-6167, @BryanLowry3