The House of Representatives passed the American Health Care Act on May 4, 2017. If you recall, less than 6 weeks earlier the same bill was being debated in the House, but was dramatically pulled from a consideration for a vote before it could occur. Politically, the bill did not have the requisite votes in the House to pass. Subsequently, there were several indicators that the bill had essentially died, but after some amendments to please both ends of the Republican party, the bill ended up making it to the House for a vote, ultimately passing.
One of the amendments that got a lot of press was regarding the ability of states to waive the rule restricting price differences based on health. However, the restriction would still apply except for those who were without health insurance for a period greater than 63 days. In order for states to waive this rule, they would need to create a program to help high-risk patients obtain insurance. The bill also provided $8 billion over a period of 5 years to help people with pre-existing medical conditions.
Clearly some people are concerned about this provision. In Wisconsin, 4 separate bills were proposed in an effort to either directly counteract elements of AHCA or head off some common concerns that could be added to the bill as it works it way through the Senate. The bills include:
S 265 prohibits health plans from imposing preexisting condition exclusions or setting rates based on preexisting conditions.
S 266 prohibits health insurance plans from imposing lifetime or annual limits.
S 267 requires coverage and prohibits cost sharing for preventative services under health insurance plans.
S 268 to require health insurance plans to cover essential health benefits as determined by the state Insurance commissioner.
Wisconsin regulates fully-insured and non-ERISA plans, like government and church health plans. So self-insured employers likely would not be subject to these requirements if passed.
So, if AHCA passes as is, and Wisconsin opts to waive some parts of the law's requirements, but Wisconsin passes the above laws, the waiver would essentially be null and not applicable to Wisconsin employers. Checkmate?
If you are concerned the some of the last minute amendments to AHCA, then you should be happy with these Wisconsin proposals. And if you think the states should be able to waive, then these proposals are effectively cutting off that waiver before it even happens. Let your state and federal representatives know your thoughts and how this will impact your employer!