The nation’s health insurers have proposed guaranteed coverage for people with pre-existing medical conditions in conjunction with an enforceable individual coverage mandate.
Under the industry proposal, health plans participating in the individual health insurance market would be required to offer coverage to all applicants as part of a universal participation plan in which all individuals are required to maintain health insurance.
Health plans also said that premium support for moderate-income individuals and broad spreading of risk are necessary to promote affordability and maintain premium stability in the individual health insurance market.
To ensure that all Americans can access coverage, health plans also reiterated their long-standing support for making eligible for Medicaid every uninsured American living in poverty and strengthening the Children’s Health Insurance Program.
“No one should fall through the cracks of our health care system,” said Karen Ignagni, president and CEO of America’s Health Insurance Plans (AHIP). “Universal coverage is within reach and can be achieved by building on the current system.”
The announcement follows a nationwide listening tour conducted by AHIP as part of its Campaign for an American Solution. The group said concerns about coverage for pre-existing conditions, continuity of coverage for those between jobs and maintaining affordability for those with insurance were raised repeatedly across the country.
The following is a summary of AHIP’s Proposal to Guarantee Coverage for Pre-existing Conditions and Promote Affordability in the Individual Insurance Market:
Guarantee-issue coverage with no pre-existing condition exclusions;
Establish an individual coverage requirement with an insurance coverage verification system, an automatic enrollment process and effective enforcement of the requirement that all individuals purchase and maintain coverage;
Promote affordability by: providing refundable, advanceable tax credits for moderate-income individuals and working families; and promoting tax equity whether coverage is obtained through an employer or the individual market; and
Ensure premium stability for those with existing coverage through a broadly funded reimbursement mechanism that spreads costs for the highest-risk individuals.
An AHIP survey of the individual market shows that individually purchased health insurance is more affordable and accessible than is widely known. The survey found that 9 out of 10 applicants undergoing medical underwriting were offered coverage. The plans commonly purchased by consumers provided substantial financial protection and a wide range of benefits, including coverage for behavioral health, prescription drugs and preventive services.
Some individuals are unable to purchase individual health insurance coverage in the private market because of their health status. Some states have addressed this issue by enacting guarantee issue legislation requiring health plans to offer coverage to all applicants. But AHIP said these reforms have often resulted in unintended consequences, including higher costs for all policyholders.
A report by Milliman, Inc. found that enactment of guarantee issue laws in the absence of requirement that individuals purchase coverage may incentivize people to defer seeking coverage until they have health problems – a situation which unfairly penalizes those who are currently insured. According to the report, states that implemented these laws saw a rise in insurance premiums, a reduction of individual insurance enrollment and no significant decrease in the number of uninsured.
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