The PROTECT Act, the health insurance reform bill unveiled last week by 18 Senate Republicans, is aptly named, albeit not for the reason its sponsors suggest.
The bill pretends to be about safeguarding Americans with pre-existing health conditions. But it’s really about protecting Senate Republicans from the stink caused by the Trump administration’s efforts to repeal the Affordable Care Act, also known as Obamacare.
According to the Kaiser Family Foundation, a huge number of people—more than a quarter of non-elderly Americans—have pre-existing conditions of the sort that would have led insurers to deny them coverage had the ACA not gone into effect. The ACA gave people who purchase their own health insurance expansive protection against such discrimination, making comprehensive coverage available and affordable to millions of Americans who’d been either priced out or shut out by insurers.
That’s one of the main reasons the public opposed GOP efforts in the last Congress to dump the ACA. Democrats pummeled Republicans over the pre-existing conditions issue in 2018, providing some of the energy behind the blue wave that swept the GOP out of the House majority that year.
In a bizarre ruling in December, however, a federal judge in Texas declared the ACA unconstitutional in its entirety. After a group of Democratic state officials appealed, the Trump administration urged the appeals court to uphold the ruling and throw out every piece of the ACA.
That’s where the PROTECT Act comes in. Designed to look like a life preserver for people with pre-existing conditions if the courts ruled against the ACA, it would bar insurers from denying coverage to an applicant or raising a customer’s premiums based on that person’s medical history.
But the bill’s protections are chimeric, as lead sponsor Sen. Bill Cassidy, R-La.—a gastroenterologist who is intimately familiar with the U.S. health insurance system—has to know.
If the ACA is repealed, insurers would no longer be required to offer comprehensive policies to all comers. All the PROTECT Act would do is encourage insurers to do something they did before the ACA: offer cheaper policies with thin coverage aimed at healthy customers, and considerably more expensive policies with comprehensive coverage for people who might actually need costly care.
The PROTECT Act would do nothing to address the biggest problems that would ensue if the ACA were obliterated by the courts. About 15 million low-income Americans would immediately lose the insurance coverage they had gained through the ACA’s Medicaid expansion. Millions more would lose the subsidies they receive through the ACA that make private insurance affordable.
The result would be chaos in the market for individual insurance plans, with an enormous number of Americans left without coverage. Perhaps the sponsors of the PROTECT Act think it’s their insurance policy in case the courts ultimately throw out the ACA. But it’s not much help for anyone else.