House bill targets healthcare exclusions

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Rep. Joseph Courtney, D-Conn.
Source: Washington Post

A congressional bill, sponsored by U.S. Rep. Joe Courtney, D-Conn., aims to reduce the instances in which an insurer can refuse to cover pre-existing conditions—health problems such as asthma, diabetes and cancer.

Pre-existing conditions can make it impossible for many people to find or afford insurance, leaving many people uninsured, incurring ruinous medical bills and sometimes postponing or skipping care they should get, Courtney said.

"The unnecessarily unfair treatment of individuals suffering from chronic or debilitating conditions by the health insurance industry must end," Courtney said Thursday after a hearing in Hartford, Conn., according to The Hartford Courant.

The bill, H.R. 2833, or the Preexisting Condition Exclusion Patient Protection Act of 2007, amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to allow a group health plan to impose a preexisting condition exclusion if:

1. such exclusion relates to a condition for which medical advice, diagnosis, care, or treatment was recommended or received within the 30-day period ending on the enrollment date; and
2. such exclusion extends not more than three months, or nine months for a late enrollee, after the enrollment date.

The bill also revises provisions that prohibit providers that offer health insurance coverage in the individual market from declining to offer coverage or imposing any preexisting condition exclusion on coverage to an eligible individual to remove eligibility requirements that require an individual to have: (1) elected COBRA continuation coverage, if it was offered; and (2) exhausted such continuation coverage, if elected.

According to The Courant, with the bill, Courtney’s goal is to help people who are moving from one employer's health plan to another or are switching from an employer's health plan to an individual health insurance policy. Under the bill, a person changing health plans could be subject to a three-month waiting period under the new plan for coverage of pre-existing health problems, instead of 12 months under current federal law.

Additionally, an insurer could look back at only 30 days of a person's health record to determine whether there are pre-existing conditions subject to the waiting period. Currently, insurers can look back six months into a person’s medical history.