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State Assembly Advances Bill Banning Pre-Existing Condition Exclusion

Proposal Includes Similar Language To Federal Healthcare Law, Proposals

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Wisconsin state Capitol
Justin Kern (CC BY-NC-ND 2.0)

Republicans in the state Assembly have passed a bill that would bar insurance companies in Wisconsin from denying coverage to people with pre-existing conditions.

Under the proposal, group health plans in Wisconsin couldn’t deny coverage to people with pre-existing conditions. They would also be barred in certain instances from considering pre-existing conditions when setting premiums for consumers. That’s similar to what’s required now under the federal Affordable Care Act and its House-approved replacement, the American Health Care Act.

During debate, Assembly Speaker Robin Vos, R-Rochester, urged Democrats to join the GOP in supporting the bill.

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“We hope that you actually join us in taking care of the people who worry the most … people who have done nothing wrong, people who are born with congenital diseases that they can’t control, people who have had cancer, people who have had heart disease,” Vos said.

However, one health care expert argued the change wouldn’t necessarily ensure patients with pre-existing conditions get adequate coverage if proposed federal reforms come to fruition.

Under the ACA, insurance companies are required to cover what are called “essential health benefits.” Under the AHCA, which has been approved by the U.S. House, states could opt out of requiring companies to cover those benefits.

“The Assembly bill is mostly window dressing,” said Jon Peacock, research director at the Wisconsin Council on Children and Families. “It won’t actually accomplish the goal of protecting people with pre-existing conditions because states would be able to waive the coverage of essential health benefits, such as prescription drugs and mental health coverage.”

Peacock said if those essential benefits are waived in Wisconsin, people could still be stuck without coverage for necessary treatments and prescription medications to treat their pre-existing conditions.

During debate, Democrats argued the bill should also include bans on lifetime and annual coverage limits.

The bill passed the Assembly on a party-line vote. It now goes to the state Senate.

Editor’s Note: This story has been updated with reporting from WPR.