HOW DOES IT PROTECT HIGH-RISK INDIVIDUALS? The amendment’s limited waiver for health rating requires states to set up a program for high-risk individuals or premium stabilization, or to participate in the federal invisible risk-sharing program. No state may obtain a waiver for health status unless it has taken these efforts to protect those who might be affected. In states with a waiver, individuals who maintain continuous coverage could not be rated based on health status.
FACT: This amendment ensures essential health benefits are the federal law of the land and maintains other important protections. States have the option to obtain a waiver regarding federal essential health benefits, but the state must publicly attest its purpose for doing so (to reduce the cost of health care coverage, increase the number of people with health care coverage, etc.) and it must specify the benefits it will require instead of the federal standard. NO STATE, under ANY circumstances, may ever obtain a waiver for pre-existing condition protection, prohibition on gender discrimination, for guaranteed issue and renewability, or for the right of dependents to stay on a family plan up to age 26.
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