Obama Administration Moves Forward to Ban Medical Discrimination Based on Pre-Existing Conditions

Providers at the Brooklyn Hospital Center’s Program for AIDS Treatment and Health (PATH) discuss a patient’s file confidentially. Photo: HRSA

On March 23, 2010, President Obama signed the Affordable Care Act and set into motion an effort that will help give all Americans, including lesbian, gay, bisexual and transgender (LGBT) Americans, more control over their health care. Through these new reforms, LGBT Americans will have better access to stable, affordable health insurance and high quality health care.

The Obama administration moved forward Tuesday to implement provisions in the health care law that would make it illegal for insurance companies to discriminate against people with pre-existing conditions. The provisions of the Affordable Care Act also would make it easier for consumers to compare health plans and employers to promote and encourage employee wellness.

“The Affordable Care Act is building a health insurance market that works for consumers,” said Health and Human Services Secretary Kathleen Sebelius. “Thanks to the health care law, no one will be discriminated against because of a pre-existing condition.”

“The Affordable Care Act recognizes that well-run, equitable workplace wellness programs allow workers to access services that can help them and their families lead healthier lives,” said Secretary of Labor Hilda L. Solis.  “Employers, too, can benefit from reduced costs associated with a healthier workforce.”

The Obama administration issued:

A proposed rule that, beginning in 2014, prohibits health insurance companies from discriminating against individuals because of a pre-existing or chronic condition.   Under the rule, insurance companies would be allowed to vary premiums within limits, only based on age, tobacco use, family size, and geography.  Health insurance companies would be prohibited from denying coverage to any American because of a pre-existing condition or from charging higher premiums to certain enrollees because of their current or past health problems, gender, occupation, and small employer size or industry. The rule would ensure that people for whom coverage would otherwise be unaffordable, and young adults, have access to a catastrophic coverage plan in the individual market.  For more information regarding this rule, click here.

A proposed rule outlining policies and standards for coverage of essential health benefits, while giving states more flexibility to implement the Affordable Care Act. Essential health benefits are a core set of benefits that would give consumers a consistent way to compare health plans in the individual and small group markets. A companion letter on the flexibility in implementing the essential health benefits in Medicaid was also sent to states.  For more information regarding this rule, click here.

A proposed rule implementing and expanding employment-based wellness programs to promote health and help control health care spending, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status. For more information regarding this rule, click here.

LGBT individuals have encountered discrimination in the health care system for decades, and many studies have shown that LGBT people are affected by chronic disease at a higher rate than straight people. The new law has already made significant progress toward ending some of the worst insurance company abuses and helping ensure that LGBT Americans have access to coverage when they need it most. For example, the Affordable Care Act ends lifetime dollar limits on key benefits and restricts annual dollar limits until they are ended in 2014, allowing for long-term comprehensive treatment of chronic diseases.

In addition, the federal website designed to help all consumers find the health insurance best suited to their needs makes it easy to locate health insurers that cover domestic partners. HealthCare.gov’s insurance and coverage finder now includes a “same-sex partner” filter, allowing same sex couples to eliminate plans which would not cover both people from the list of plans available in their area. Consumers looking for information on domestic partner coverage will also have access to HealthCare.gov’s regular features, such as the ability to sort based on the enrollment, a plan’s out-of-pocket costs or other categories. The same-sex partner filter is also available for small employers looking for information on the small group market.

Source: U.S. Department of Health & Human Services