Senate GOP amends healthcare bill to add waiting periods for those with coverage gaps

The Senate side of the United States Capitol in Washington, D.C.
The Senate has amended the Better Care Reconciliation Act in a bid to make up for the possible ill effects of repealing the ACA's individual mandate.

Senate Republicans have added a provision to their healthcare overhaul bill that appears to be an attempt to lessen the blow of repealing the Affordable Care Act’s individual mandate.

A new provision outlined in an amended draft (PDF) of the Better Care Reconciliation Act of 2017 would allow insurers to impose a six-month waiting period on individual market enrollees who had a gap in coverage of at least 63 days or more in the 12 months before submitting an application for a new plan.  

There are certain exceptions to the provision—for example, it doesn’t apply to newborns, and it would still allow individuals to move from one individual market plan to another or reenroll in the same plan, even if they had an earlier gap in coverage.

UPDATE: Senate delays vote on ACA repeal, replacement bill

The purpose of the amendment is to compel people to remain covered continuously and not just sign up when they require health services. The ACA’s individual mandate—which imposed a tax penalty on those who did not sign up for and maintain coverage—already provided a similar incentive, though it was one of the law’s least popular provisions.

The repeal of the individual mandate under the Senate’s healthcare bill would cause fewer people to enroll in individual market, employment-based and Medicaid plans, according to the Congressional Budget Office’s score (PDF) of the bill.

Some experts are skeptical that the waiting periods would be very effective at compelling people to stay insured, according to The New York Times. Others, like the American Enterprise Institute’s Joseph Antos, think the concept would offer “a better incentive to stay in coverage.”

The amendment may also help ease at least one concern insurers have about the Senate bill. Indeed, Kaiser Permanente Chairman and CEO Bernard Tyson wrote in a statement last week that “we are concerned that the repeal of the individual mandate without alternative incentives for enrollment likely will lead to fewer people enrolled and higher premiums.”

But Tim Jost, a healthcare policy expert from Washington and Lee University, pointed out that the policy would make those with a coverage lapse wait even longer to reenroll than under the ACA, which required most to wait until the next open enrollment period.

“Six months may mean the difference between life and death for a person with cancer awaiting treatment,” he wrote in a Health Affairs Blog post.

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