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The U.S. Senate just voted to allow the expansion of short-term, or “junk insurance” plans that are not required to cover pre-existing conditions. 

Sen. Martha McSally (R-Ariz.) joined her Republican colleagues in the 52-43 vote, rejecting a Congressional Review Act (CRA) resolution that would have overturned a Trump administration waiver rule giving states the green light to use taxpayer dollars to promote short-term insurance plans. Every Senate Democrat, including Arizona’s Kyrsten Sinema, supported the resolution. 

McSally’s vote against the proposal comes despite repeated assurances that she will fight to protect coverage for the 2.8 million Arizonans with pre-existing medical conditions.

In September, McSally told the Washington Examiner that we are “never going back to where somebody who has a pre-existing condition is going to be denied health insurance.”

She also held two tele-town halls in September, during which she promised that “people with pre-existing conditions will be protected” and that “we are not going back to the days of old where people with pre-existing conditions cannot get access to health insurance.”

She reiterated those promises outside a closed-door event on Oct. 9, and again at a campaign meet-and-greet the very next night.

McSally’s critics, including Rep. Ruben Gallego (D-Ariz.), accused her of breaking those promises with her vote on Wednesday. 

“From her first day in Congress, Martha McSally has asked us to take her at her word and ignore her voting record. She said that she would protect Arizonans’ health care coverage, but today she once again voted against common sense protections for people with pre-existing conditions,” Gallego said in a statement. “Martha McSally showed Arizonans why her word can’t be trusted.”

“Junk insurance” plans have received mostly criticism for their lack of coverage for pre-existing conditions, but they can also deny coverage for things like maternity care, mental health and prescription drugs. They may also cap doctor visits, place low limits on emergency room care and hospital visits, set higher deductibles and raise out-of-pocket costs.

The plans also frequently leave families facing surprise bills, which is exactly what happened to Arizona resident Marisia Diaz after she unwittingly bought a “short-term” insurance plan when she thought she was purchasing a comprehensive plan for medical care. 

Diaz told Bloomberg that she only became aware of just how little her family’s plan covered after her husband, David, had a double heart bypass operation in 2017. Six months later, they were shocked to receive a bill for $244,447.91. Diaz’s story isn’t an anomaly; the companies behind these plans have repeatedly come under fire for misleading policyholders and engaging in deceptive marketing practices.

Short-term insurance plans were originally included in the Affordable Care Act (ACA) as a temporary, three-month option for those experiencing a short gap in coverage, including those individuals between jobs, but the Trump administration changed the policy in 2018, extending the limit to three years. 

Republicans have marketed short-term insurance plans as a cheaper alternative for healthier customers, but the expansion of the plans has been met with backlash from patient advocates and doctors alike. The American Medical Association also criticized junk insurance plans, saying “short-term health plans will bring long-term pain for patients,” while the AARP said the plans would allow insurance companies to “impose an age tax, charging older Americans much higher premiums.” 

Democrats and left-leaning groups have opposed the plans as well, claiming the expansion of short-term plans is part of a coordinated Republican effort to undermine the ACA by drawing healthier people away from its marketplace.

This fear isn’t without basis; a 2018 Kaiser Family Foundation report found short-term plans could destabilize the ACA exchange market, leading to higher premiums for policyholders and leaving more people uninsured.

Wednesday’s Senate vote means the proliferation of junk insurance plans will continue across the country, including in Arizona, where state lawmakers passed a law this year matching the Trump administration’s rule allowing short-term plans to be extended for up to three years. 

While the Trump administration’s short-term insurance policy is still being challenged in the courts by health organizations, the Congressional Budget Office estimated that 600,000 new enrollees will have signed up for short-term plans by the end of 2019 — a 600 percent increase over the number enrolled at the end of 2018.