This State Just Showed What Insurance Without Obamacare Might Look Like

January 24th 2017

As the Trump administration moves toward repealing the Affordable Care Act, what the health insurance market might look like in the future is starting to come into focus.

Judging by legislation passed by the Minnesota State House of Representatives, it could be extremely difficult for people with pre-existing conditions to get the healthcare they have now.

Tacked onto a bill promising health insurance premium relief to Minnesota residents was an amendment that would allow health insurance companies to exclude nearly three dozen conditions from the health plans they offer — once Obamacare is repealed. 

The list was posted on Facebook by former candidate for state representative Lindsey Port, soon becoming a viral example of the kind of bare-bones insurance that will end up being the only affordable option for those without employer-provided coverage.

Among those who shared it was Andy Slavitt, the former Obama administration official who ran the Centers for Medicare and Medicaid, the government's chief arm for enforcing the Affordable Care Act. He claimed that if the reforms the Trump administration wants do in fact come to pass, amendments like these — effectively stripping people with pre-existing conditions of quality care — will be repeated around the country.

The Minnesota amendment demonstrates the the only thing keeping Minnesotans from being denied coverage for common conditions right now is the Affordable Care Act.

"Notwithstanding any state or federal law to the contrary, a health plan company may  offer health plans that do not include federally required health benefit mandates," the amendment reads, listing dozens of conditions that need not be covered, from cancer to diabetes, and services that need not be provided, from mental health care to prenatal care. It even allows companies to discriminate against unmarried women who are pregnant.

Affordable Care Act expert Louise Norris told health insurance advocacy site that it's likely the state will make carriers offer at least one plan with no pre-existing condition clause. But there's no guarantee it will be affordable.

"Carriers would have to offer at least one plan with all the mandated benefits," Norris writes, "and the rest could be a free for all. Of course, that means people with health conditions would end up on the high-quality plans [...] [but] the result would be skyrocketing premiums for the more robust plans."

While the bill has passed the Minnesota state house, it still has multiple hurdles to clear before it can become law.

The bill passed the state Senate earlier in the week, without the pre-existing conditions amendment passed by the house. The two chambers now need to reconcile their differences.

If a final bill can be negotiated, it would go to Democratic governor Mark Dayton. Dayton has not indicated what he'll do with it, but he previously claimed  Obamacare was "no longer affordable" for many residents, a statement he walked back a week later.

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