WASHINGTON (CN) - While Senate Majority Leader Mitch McConnell scrambles to secure the votes he will need to pass the Senate's health care bill as early as next week, experts weighed-in Friday on how it could affect provisions of the law that expanded coverage for more Americans.
The Senate bill, called the Better Care Reconciliation Act of 2017, on its face keeps the requirement of the Patient Protection and Affordable Care Act to cover those with preexisting conditions.
A GOP Senate staffer said Thursday that states could "absolutely not, categorically not, completely not” waive requirements for insurers to cover them under the new bill.
However, former Medicaid official Eliot Fishman called that assertion false for several reasons.
Fishman, now the health policy director for nonpartisan health advocacy group Families USA, said the bill would allow insurers to charge older people more for their coverage, something they are not allowed to do under the ACA. At the same time, the Senate bill reduces premium assistance for them.
"That's just a proxy for discriminating against people with preexisting conditions," Fishman said in an interview.
The Senate bill also allows states to waive essential health benefits, which they are required to cover now under the ACA. That could also limit coverage to those with preexisting conditions.
Those benefits include emergency services and hospitalization, but also maternity and mental health care, substance abuse treatment, prescription drugs, rehabilitative and laboratory services, chronic disease management and pediatric services.
Fishman said that in states that waive essential health benefits, insurers that don't want to cover preexisting conditions that fall within them could then opt out of covering them.
"If there's anything that we learned from the way the individual markets worked before the Affordable Care Act, it's that the pressures on insurers are so intense to avoid people with preexisting conditions, if there's a way for them to do it they will take advantage of it," Fishman said.
"It's not because they're evil, it's because it's financial suicide for them not to if they're allowed to," he added. "And if they don't, everyone else will and they will be stuck with all those high costs."
Under the Senate's plan, Fishman also believes that premium costs will rise and quality of insurance plans will drop.
Under the ACA's subsidized plans, out of pocket costs for patients can't exceed more than 30 percent of an insurance premium. But the Senate bill would leave individuals responsible for covering 42 percent of their costs through a combination of premiums, deductibles and co-pays.
The Senate bill would also eliminate the ACA's cost sharing subsidies in 2019, which are federal payments made to insurers to cover the costs associated with offering plans with significantly lower deductibles to low and middle income people.
More than half of policyholders on the ACA exchanges benefit from reduced deductibles and co-pays because of cost sharing subsidies. While the Senate bill would allocate funds for them for two more years, consumers will feel a burden once they go away.
"Not only are the overall out of pocket costs going up, but the source of government assistance to help people deal with those out of pockets costs is now going away," Fishman said.