An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 185.983 (1) (intro.); to create 609.847 and 632.728 of the statutes; Relating to: coverage of individuals with preexisting conditions and benefit limits under health plans.
Summary
SB174 would create a state-law backstop for health insurance consumer protections if the federal Affordable Care Act’s relevant provisions stop applying or no longer preempt Wisconsin law. In that event, the bill would require individual and group health benefit plans to accept applicants regardless of preexisting conditions, allow only limited premium rating factors, require a statewide open enrollment period of up to 45 days plus special enrollment periods for qualifying events, and prohibit preexisting condition exclusions and annual or lifetime dollar limits on benefits.
The bill also applies these protections to certain self-insured governmental health plans and to limited service health organizations, preferred provider plans, and defined network plans through a new cross-reference. It amends several existing statutes governing state employee coverage, local government self-insured plans, school district self-insured plans, and voluntary nonprofit health care plans to incorporate the new coverage rules or related existing insurance protections. The bill is expressly conditional: it would take effect only if specified ACA provisions are no longer enforceable or no longer preempt state law, and it includes exemptions for plans already exempt from the corresponding federal requirements.
Impact
If triggered, SB174 would substantially alter Wisconsin insurance law by codifying ACA-like market reforms in state statute and superseding conflicting provisions in the insurance code and related chapters. It would affect individual and small-group market insurers, self-insured health plans, certain governmental plans, and some nonprofit cooperative health plans, while preserving exemptions for plans not subject to the comparable federal rules. The bill would also require the insurance commissioner to administer a statewide open enrollment period and would likely be treated as a health insurance mandate with potential fiscal and social impact review.
Sentiment
The available record shows no committee transcript or recorded votes, so there is no documented floor or committee debate to gauge detailed sentiment. The bill’s structure and sponsorship suggest support for preserving consumer protections against discrimination based on health status, and its conditional design indicates an effort to prepare for a possible change in federal law rather than immediately rewrite current coverage rules. The bill ultimately failed to pass pursuant to Senate Joint Resolution 1.
Contention
The main policy issue is whether Wisconsin should lock in ACA-style protections in state law as a contingency, especially the guaranteed issue requirement, limits on rating factors, and bans on preexisting condition exclusions and benefit caps. Supporters would likely view these provisions as necessary consumer protections and continuity safeguards if federal law changes, while opponents may object to the added regulatory burden on insurers and self-insured plans, the potential mandate implications, and the expansion of state insurance oversight. Another point of contention is the bill’s conditional trigger, which makes its practical effect dependent on future federal court or preemption developments.
Crossfiled
An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 185.983 (1) (intro.); to create 609.847 and 632.728 of the statutes; Relating to: coverage of individuals with preexisting conditions and benefit limits under health plans.