House Democrats Unveil Bill Aimed at Shoring Up ACA Patient Protections, Affordability

A day after the Trump administration reversed course on the Affordable Care Act (ACA) by telling the Fifth District Court of Appeals it agreed with a lower court’s opinion that the entire law is unconstitutional, House Democrats introduced a bill that aims to protect the patient protections enshrined in the ACA.

Called the “Protecting Pre-Existing Conditions & Making Health Care More Affordable Act of 2019,” the bill is an effort to lower health insurance premiums by expanding eligibility for premium tax credits beyond 400% of the federal poverty line and increasing the size of tax credits for all income brackets. The legislation also creates a national reinsurance program to help cover care for patients with costly conditions, and offers funding to states to establish their own state-based marketplaces.

The bill was introduced Tuesday by Energy and Commerce Chairman Frank Pallone Jr, D-New Jersey; Ways and Means Chairman Richard Neal, D-Massachusetts; and Education and Labor Chairman Bobby Scott, D-Virginia.

“This comprehensive proposal follows through on our commitment to make healthcare more affordable and to defend critical protections for the more than 133 million Americans living with pre-existing conditions,” Pallone said in a statement.

Late Monday, the Department of Justice said it now backs the December 2018 ruling from a district court judge in Texas that said the entire ACA is invalidated without the individual mandate, which was removed when Congress reduced the penalty to $0.

The bill introduced Tuesday includes:

• An expansion of subsidized coverage in the marketplaces by defining affordability as the cost of coverage for a family, not just an individual.
• A reversal of the administration’s final rule on short-term health plans, as well as association health plans, which are not as comprehensive as plans compliant with the ACA.
• A requirement for plans to include essential health benefits, broad coverage of prescription drugs, and prohibit substitution of benefits across benefit categories.
• Restoration of funding for outreach navigators to $100 million a year.
• A prohibition on the administration from marketing plans that are not compliant with the ACA.
• A reinsurance program for states, or allows them to use the funds for premium subsidies or cost-sharing support; it also sets up a default federal reinsurance program.
• A reversal of the October 2018 waiver guidance that the Democrats say weaken the guardrails that requires Section 1332 state innovation waivers to maintain a certain level of affordability, coverage and comprehensives. It also prohibits proposals that would allow tax subsidies for less-comprehensive plans.
• A provision of $200 million a year from 2020 to 2020 to states that want to conduct feasibility studies, pilot programs, technology upgrades and other efforts.