HIPAA required that as long as someone had beencontinuously covered by health insurance for at least 12 months,without a break longer than 63 days, new insurance at a new jobcould not impose waiting periods.

During a recent appearance on MSNBC, Sen. Chris Coons (D-Del.)answered questions from “Morning Joe” co-host Mika Brzezinski aboutthe latest lawsuit challenging the constitutionality of theAffordable Care Act. “The most important part of Obamacare, as youknow, Mika, is the protection against pre-existing condition discrimination thatextended to more than 150 million Americans, folks who get theirhealth insurance through their employer,” he said.

Because, as almost everyone agrees, health care is complicated, KHN decided to take a closer look atCoons' statement, especially because much has been written and said— and put in campaign ads — about how many Americans have pre-existing health conditions and howthey gained insurance protections under the ACA.

Related: States attacking ACA's pre-existing conditionprotections have the most to lose

We will not attempt to judge Coons' assertion that the ACA'sprotection for people with pre-existing conditions is “the mostimportant part” of the law, although it is often mentioned alongwith the expansion of Medicaid to millions more Americans with lowincomes.

We started out by contacting Coons' office to get the backgroundinformation on his assertion but didn't hear back. So, we moved onto examining the statutes and talking to various experts.

First came HIPAA

What we found out is what few people realize: Protections forpre-existing conditions for most people with job-based insurancepredated the ACA by more than a decade.

The Health Insurance Portability and Accountability Act of 1996, orHIPAA, is best known for its provisions regarding medical privacyand patient access to their medical records. But the principalpurpose of the law was to put an end to what was known as “joblock.” That happened when people with pre-existing healthconditions were afraid to leave one job with insurance for anotherjob with insurance because the new insurance would not cover theircondition, or would impose long waiting periods.

“HIPAA was a big advancement at the time in terms of protectingpeople with pre-existing conditions who had employer coverage,”said Sabrina Corlette, a research professor who studies healthinsurance at Georgetown University.

Specifically, HIPAA required that as long as someone had beencontinuously covered by health insurance for at least 12 months,without a break longer than 63 days, new insurance at a new jobcould not impose waiting periods for a worker or family member.HIPAA also required insurers who sold policies in the small-groupmarket to sell to all small groups, regardless of health status,and to cover every eligible member of the group, also regardless ofhealth status.

Most of the states had already attempted to address the job-lockproblem by the mid-1990s, but states could not reach the majorityof the population with health insurance because they were coveredby the federal Employee Retirement Income Security Act, orERISA.

“HIPAA basically ratified what most states had already done,”said Joel Ario, a former Pennsylvania state insurance commissionerwho helped implement the ACA for the federal government.

HIPAA also tried to smooth the transition from employer-basedinsurance to individual coverage by requiring insurers to offercoverage to people who exhausted their post-employment COBRAbenefits. (COBRA, short for the Consolidated Omnibus BudgetReconciliation Act, was a 1986 law that allowed workers to continueto purchase their employer plans at full cost for up to 18 months.)But HIPAA did not address how much insurers could charge for thoseplans, and many insurance companies tried to deter enrollment bymaking premiums unaffordable for nearly anyone who qualified.

While the group-to-individual conversion problem was the mostglaring gap in HIPAA, it was not the only one. HIPAA did notrequire employers to offer health coverage nor did it require thosewho did offer coverage to offer a minimum package of benefits.

Most of those gaps were addressed by the ACA. It effectivelyrequired large employers to provide a minimum package of benefits(or else pay a substantial fine). The ACA also, for the first time,requiredinsurers to sell policies to individuals with pre-existingconditions — without charging them more. Much of HIPAA was writteninto the health law, making the relationship between the twomeasures even more complicated.

Our ruling

In this statement, Coons suggested that the ACA providedpre-existing condition protections to the more than 150 millionAmericans who get their health coverage through their place ofemployment.

But it is not completely correct. Those were already in placethrough HIPAA, though expanded by the ACA.

We rate Coons' statement as Half True.

Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

Read more: 

• Impact of pre-existing-condition coverage lawsuitdepends on where you live
• Majority of GOP voters support pre-existingcondition coverage
• Unusual alliances form to oppose ruling that foundthe ACA unconstitutional