An Obamacare sign is displayed on the storefront of an insurance agency in Hialeah, Fla., on May 11, 2017. Ohio Gov. Mike DeWine says if the health-reform law is ruled unconstitutional, he’ll “guarantee” new state-level rules to protect people with pre-existing conditions. But there’s concern that creating such rules would be inadequate and lead to lawsuits.
COLUMBUS, Ohio—Gov. Mike DeWine has said that if the entire Affordable Care Act is ruled unconstitutional, he guarantees that his administration would seek state-level rules to ensure that Ohioans with pre-existing conditions can’t be denied insurance coverage.
But if Obamacare falls, there’s no guarantee that state lawmakers would agree to pass such rules. And there are concerns that any state-level protections would be an inadequate substitute for what the ACA currently provides and result in Ohio being hit with a flurry of new lawsuits.
“It would be kind of mass confusion as to which plans could possibly be covered by state law, and probably a new set of legal challenges,” said Micah Berman, an associate public health and law professor at Ohio State University. “It’s extremely difficult to do on the state level.”
DeWine made his guarantee after the Trump administration announced earlier this week it will reverse course and support a federal judge’s ruling that the entire Affordable Care Act is unconstitutional. That ruling is on hold pending appeal.
DeWine, as well as fellow Ohio Republicans Lt. Gov. Jon Husted and Attorney General Dave Yost, say that only the ACA’s controversial individual mandate should be abolished, not the part of the law prohibiting insurance companies from denying health coverage to someone because of a pre-existing medical condition.
If the courts throw out the entire law, the governor would then ask the Ohio General Assembly to pass legislation ensuring coverage of pre-existing conditions, according to DeWine spokesman Dan Tierney.
Exactly what such a bill would look like isn’t clear, Tierney said, because it would depend on the courts’ ruling.
However, Tierney pointed out that if the ACA’s pre-existing condition protections are thrown out, it would only affect individuals who haven’t had health insurance for at least six months. That’s because another federal law, the Health Insurance Portability and Accountability Act (or HIPAA), would continue to provide pre-existing condition safeguards for those who already have health insurance and are switching plans.
“You would have to go six months without insurance before somebody could deny your pre-existing condition,” Tierney said. “That would certainly be a period of time you would have to go and address with [state] legislation before somebody would be hit with the opportunity for an insurer to deny their pre-existing condition when they signed up for a new policy.”
But Berman said the problem with such a move is that it would only help people who already have health insurance. If the ACA is struck down, about 700,000 low-income Ohioans enrolled in the ACA’s expanded Medicaid coverage would lose their health-care benefits.
“There obviously could be something done [by the state] to minimize the damage,” Berman said. “But it would not come close to providing the same level of protection that the ACA does.”
Tierney said that if the courts overturn Medicaid expansion, DeWine would seek recommendations on what to do from the directors of the Ohio Department of Medicaid and the Ohio Department of Health.
Greg Lawson, a senior policy analyst for the conservative-leaning Buckeye Institute in Columbus, said that if the ACA’s pre-existing condition rules disappear, any state-level replacement would create a “tumult.”
Instead of regulating coverage of pre-existing conditions, Lawson suggested that Ohio could examine other options to help hard-to-insure Ohioans – such as a high-risk pool, in which insurance companies impose a customer surcharge to help subsidize coverage for those with higher medical bills.
But no matter what the state might do about pre-existing conditions, Lawson said, it won’t solve the underlying problem that health care costs are, overall, too high.
“We keep doing these things and stopgap mechanisms to …kind of put a band-aid over the fundamental problems,” he said.
Jeremy Pelzer, Cleveland Plain Dealer, March 28, 2019
Gov. Mike DeWine’s vow to protect pre-existing condition coverage may bring unwanted side effects