A series of three bills that would put provisions of the federal Affordable Care Act (ACA) into state law passed the Pennsylvania House of Representatives on Wednesday with bipartisan support, despite — or in some ways, because of — the ongoing political battle over the law commonly known as Obamacare.
All of the bills contain clauses specifying that the state-level rules would only be enacted if Congress were to repeal the corresponding part of the ACA, a court was to invalidate it, or a future president was to refuse to enforce it.
Since the ACA’s passage into law by Democrats under then-president Barack Obama in 2010, the healthcare policy has been “under constant legal and political attack,” said Rep. Dan Frankel, D-Allegheny County, the sponsor of one of the bills.
Further challenges to the ACA are expected to go before the U.S. Supreme Court, and the willingness of the government to defend the law may depend on the outcome of next month’s election.
“While we hope these challenges will fail, hope is not enough,” Frankel said, and Pennsylvania “cannot rely on federal policies to protect our citizens. We can and we must enshrine these protections in state law.”
The bills cover three of the main elements of the ACA. The first would bar health insurers from enacting annual or lifetime benefit caps on certain core health services, including ER visits, maternal care, mental health treatment, and other items that are deemed essential benefits under the ACA.
The second bill would allow parents to keep their children on a family health insurance plan until age 26, another of the major tenets of Obamacare. The third bill would prohibit insurance companies from denying coverage or raising premiums due to a patient’s pre-existing conditions.
The ACA was a frequent point of attack for Republicans, who believed the law was too restrictive and forced patients to pay for benefits they didn’t need. While initially unpopular, public opinion of the ACA has improved greatly since then, according to polling from the Kaiser Family Foundation. The prohibition on denying coverage for pre-existing conditions polls at 72% support, according to KFF data.
Political interest in eliminating the law has waned. The GOP’s best shot at repealing the ACA came in 2017, but was voted down by Republicans — most famously the late Arizona Sen. John McCain — who felt the lack of replacement legislation would simply drive up prices for sicker people.
All three of the bills passed the House on Wednesday with all Democrats — who hold a slim majority — in favor, along with over half of the Republican caucus in each instance. The bills now head to the state Senate, where the GOP holds a majority.
Following committee votes last month, the ranking Republican told PennLive that the caucus didn’t feel the bills were worth fighting given that they are largely speculative on future court rulings. Some Republicans have also said they don’t see some of the provisions as an endorsement of the ACA per se.
The protections for pre-existing conditions are “not necessarily a new benefit,” said Rep. Bryan Cutler, R-Lancaster, the GOP’s floor leader, but rather “one that has been carried forward in various iterations of the law” that existed prior to the ACA.
Previous legislation, such as the 1996 Health Insurance Portability and Accountability Act (HIPAA), included language on pre-existing conditions but did not feature the limits on premium costs or prevent coverage exclusions in the way the ACA does.
As noted by Rep. Eddie Day Pashinski, D-Luzerne County, a core concept of the ACA is to keep young, healthy people paying into insurance plans in order to counter the losses from older, sicker patients. The law encourages this by guaranteeing coverage for preventative procedures, allowing children to stay on their parents’ plans longer, requiring most employers to offer coverage, subsidizing insurance bought on state-run exchanges, and other provisions.
“Losing health insurance leads to many other problems and it also led to young, healthy individuals leaving the health insurance market entirely,” Pashinski said, and the lack of those individuals to balance out those with more acute needs “caused insurance to become unaffordable for many people.”
How exactly a replacement healthcare law would work around this problem remains unclear. Ohio Sen. JD Vance, the GOP’s vice-presidential candidate, said recently he would support allowing insurers to place sicker patients in separate risk pools, which is expected to lower premiums for healthier people but make care much more expensive for those with costly pre-existing conditions.
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