People with pre-existing medical conditions could lose their individual health insurance coverage if a judge rules in favor of the 20 states currently suing the federal government over the constitutionality of the Affordable Care Act.
And they’ve been given a helping hand by the Trump administration: That’s because the Justice Department has declined to defend the law and the pre-existing conditions provision in court, an “unusual” move that could affect millions of people.
Last year, during the GOP’s attempt to repeal and ACA, the possible loss of health insurance coverage for people with pre-existing conditions and disabilities was one of the most potent rallying forces against the repeal. Constituents across the country made it known that they were not going to back to the days when they could be charged more for conditions like high blood pressure or asthma, or denied coverage all together if they were battling cancer. Republicans, including President Trump, pledged again and again that the protections were safe.
But promises never last long in politics. Now, less than a year later, guaranteed coverage for people in the individual market is on the line again, thanks to the Trump administration’s inaction (the Justice Department actually filed a briefin support of the conservative states’ contention that the protections are unconstitutional). “By withdrawing from defending the law in court, the Trump administration is saying it no longer supports those consumer protections,” reports NPR. The administration did argue that other parts of the ACA, like the Medicaid expansion, are unconstitutional.
Dania Palanker, assistant research professor at Georgetown’s Center on Health Insurance Reforms, writes in an email that the Trump administration’s position on the case is “extraordinarily serious.”
“The Trump Administration is trying to make an end run around Congress by encouraging the courts to take away pre-existing condition protections Congress chose to keep as law,” she writes. “If the courts side with the Administration, the health insurance markets could be pushed into chaos.”
That’s because the individual market would likely revert to the pre-ACA days, when sick people were routinely denied coverage for chronic conditions and illnesses, and women paid more for insurance based on their gender.
Sick People Will Lose Coverage
According to the Kaiser Family Foundation, 27 percent of adults under 65 in the individual market have a pre-existing medical condition that could preclude them from coverage if the ACA—or its community rating provision—is repealed. The Department of Health and Human Services estimates that 133 million non-elderly Americans have a condition that could make them uninsurable or face “exorbitant” costs if the protections disappear.
As Larry Levitt, senior vice president of Kaiser, explains, “18 percent of individual insurance applicants were denied coverage before the ACA. Others didn’t even bother applying because they knew they had pre-existing conditions that made them uninsurable.” Still others were given coverage that did not include treatments for the conditions they did have.
And it’s not just life-threatening conditions like cancer or kidney disease that would preclude you, though that would be egregious enough. Eating disorders, acne, obesity, sleep apnea, and mental illnesses like depression were all used as reasons to deny insurance just a few years ago. Trans people, too, were denied, as were people with certain careers, including window washers, taxi drivers and pilots.
Overturning these protections also “opens the door for insurance company abuses such as recessions—the search for undisclosed medical histories that can justify denying claims, even when the undisclosed conditions have nothing to do with the claim,” according to the Los Angeles Times.
You can see on this insurance application, tweeted by Levitt, what insurers were looking for.
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