Health insurance companies await court ruling on ACA

Some national health insurers will keep consumer-friendly reforms — regardless of whether the U.S. Supreme Court strikes down the Affordable Care Act in the coming weeks. One large Wisconsin insurance company is waiting before acting.

Some of what insurers are proposing to keep from the federal health law are already part of Wisconsin law: namely, keeping children 26 and under on their parent’s policy. A high court decision to strike some or all of the ACA won’t change that. What the ruling could affect are a company’s ability to deny coverage after someone gets ill, change lifetime coverage limits and provide free preventive health services. National insurers like UnitedHealth Group, Aetna and Humana say they’ll continue these reforms. David Huttleston is a Madison healthcare consultant and actuary. He says yanking benefits would be a burden for insurance companies and might result in customer backlash: “So they’re getting marketing out of this. They’re saying, ‘We’re going to do it anyhow.’ That’s because backing off would cost them more than going forward.”

A health insurer with the third largest market share in Wisconsin is taking a wait and see approach. Michael Heifetz is vice president of governmental affairs for Dean Clinic: “Wisconsin has always been more progressive in its insurance environment. So our customers wouldn’t see much difference in that regard. And many of the things that some of these large, national insurers are doing, frankly they were the ones reform was targeting for some of the problems consumers were seeing.”

The problems Heifetz mentioned included “rescission,” when an insurer denies further coverage after a serious illness. Health reform also would require coverage of children with pre-existing conditions. But insurers aren’t promising to implement that; it will remain up to the court which provisions, if any, remain in force.