Buzz
If a judge rules in favor of the 20 states challenging the constitutionality of the Affordable Care Act, those with pre-existing conditions might lose their individual health insurance coverage.
The Trump administration has added fuel to the fire by refusing to defend the law and its provisions protecting those with pre-existing conditions in court, an unusual move with far-reaching consequences for millions.
When the GOP attempted to repeal the ACA last year, the threat of losing health insurance for people with pre-existing conditions and disabilities became a key motivator in opposition to the repeal. Across the nation, constituents made it clear they wouldn't go back to a time when conditions like high blood pressure or asthma could result in higher charges, or cancer patients could be denied coverage. Republicans, including President Trump, assured the public that these protections would remain in place.
However, political promises don't always hold. Less than a year later, thanks to the Trump administration's failure to act, guaranteed coverage for individuals in the marketplace is once again at risk. The Justice Department even filed a brief supporting the states' argument that the protections are unconstitutional. As NPR reports, by not defending the law in court, the Trump administration signals its abandonment of those consumer protections, though it continues to argue that other ACA components, like Medicaid expansion, are unconstitutional.
Dania Palanker, an assistant research professor at Georgetown’s Center on Health Insurance Reforms, emphasizes in an email that the Trump administration's stance on the case is 'extraordinarily serious.'
'The Trump Administration is attempting to bypass Congress by persuading the courts to strip away the pre-existing condition protections that Congress has kept as law,' she explains. 'If the courts rule in favor of the Administration, the health insurance markets could be thrown into disarray.'
This is because the individual market would likely regress to the pre-ACA era, where individuals with chronic illnesses were routinely denied coverage, and women faced higher insurance premiums simply due to their gender.
People with Pre-Existing Conditions Would Lose Coverage
The Kaiser Family Foundation reports that 27% of adults under 65 in the individual market have a pre-existing condition that could make them ineligible for coverage if the ACA or its community rating provision is repealed.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 render them uninsurable or subject them to 'exorbitant' costs if the protections are removed.
Larry Levitt, senior vice president of Kaiser, highlights that '18 percent of individual insurance applicants were denied coverage before the ACA. Many others didn't even apply, knowing their pre-existing conditions made them uninsurable.' Some applicants were offered coverage that excluded treatments for their existing health issues.
It wasn’t just life-threatening illnesses like cancer or kidney disease that resulted in denial, although that would have been egregious enough. Conditions such as eating disorders, acne, obesity, sleep apnea, and mental health conditions like depression were also grounds for denial. Transgender individuals and certain workers, like window washers, taxi drivers, and pilots, were also frequently rejected.
Eliminating these protections 'also paves the way for insurance company misconduct such as recessions—the practice of searching for undisclosed medical histories to justify rejecting claims, even when those conditions aren't related to the claim,' reports the Los Angeles Times.
As shown in this insurance application, shared by Levitt on Twitter, you can see exactly what insurers were looking for.
Women would once again face higher charges simply because of their gender.
Before the ACA, gender-based pricing was standard practice, where women paid higher premiums for the same coverage as men. Women’s insurance costs could be up to 1.5 times that of men’s premiums.
The discrimination didn’t stop there: C-sections and a history of domestic violence were often used to deny coverage (though it’s crucial to note that while women are more commonly affected, domestic violence is not exclusive to them). Even the potential of pregnancy was treated as a pre-existing condition. In some cases, women had to purchase an additional pregnancy rider for coverage at extra cost.
Younger individuals will pay lower premiums.
Because the sickest Americans would be excluded, younger, healthier people would benefit from lower premiums—until they got sick. At that point, insurers could cancel their coverage if they were diagnosed with an illness or faced any other health issue requiring care.
On the other hand, older individuals would face higher premiums or even be excluded from the market entirely.
Whether the states win the lawsuit or not, insurers are taking advantage of the uncertainty to raise premium prices for the upcoming year. While many individuals in the market qualify for subsidies to help with their costs, others don't—and they are already feeling the financial strain.
