If Trump administration has its way, insurance coverage for pre-existing conditions could cost you more

The Affordable Care Act is back in court again. In February, 20 Republican states, led by Texas, filed a lawsuit cla...

Posted: Jun 14, 2018 11:59 PM
Updated: Jun 14, 2018 11:59 PM

The Affordable Care Act is back in court again. In February, 20 Republican states, led by Texas, filed a lawsuit claiming that when Congress reduced the tax penalty (which most people must pay if they fail to have health insurance) to zero in the 2017 tax bill, it rendered the ACA's individual mandate unconstitutional. Without the mandate, the states maintained, the entire ACA is invalid.

In April, the Republican states filed a motion asking Judge Reed O'Connor to enter an order blocking the enforcement of the ACA and all regulations issued under it. In May, California and 16 other Democratic states intervened to defend the ACA. But the Texas lawsuit was so absurd that it garnered little attention.

On June 7, however, the Trump administration's Department of Justice responded to the lawsuit, giving it new credibility. The administration's brief agreed with Texas that the tax bill had made the individual mandate unconstitutional, but contended that unconstitutionality only invalidated the ACA's "guaranteed-issue and community-rating provisions" and not the rest of the ACA. These provisions require that insurers offer coverage to all applicants at the same premium regardless of preexisting conditions.

The Trump administration apparently adopted this position at the last minute, surprising even Republicans in Congress. On Tuesday, Republican Senate Health Committee Chair Lamar Alexander declared, "The Justice Department argument in the Texas case is as far-fetched as any I've ever heard. Congress specifically repealed the individual mandate penalty, but I didn't hear a single senator say that they also thought they were repealing protections for people with pre-existing conditions."

A senior Justice Department attorney on the case resigned last Friday, rather than sign the brief.

But the Trump administration's brief makes it more likely that Judge O'Connor, who has a history of hostility to the ACA, will take the Texas complaint seriously.

What happens if Texas wins the lawsuit and the decision is upheld on appeal? Invalidation of the entire ACA, which Texas seeks, is unlikely, as it would create chaos throughout our health care system. Medicare beneficiaries would lose access to some preventive services, and it is possible that Medicare would not be able to pay doctors and hospitals at all.

But even the more limited invalidation that the Trump administration seeks would have dramatic effects. An estimated 50 to 130 million Americans have preexisting conditions, such as arthritis or diabetes. If the Trump administration has its way, insurers could deny coverage or charge higher premiums to consumers with preexisting conditions in the individual market or exclude their preexisting conditions from coverage, unless prohibited by state law.

The online insurance marketplaces would likely no longer be able to help consumers compare plans and premiums because each individual could be charged a premium based on his or her health status, gender, and age. Ten to 12 million Americans who currently receive premium tax credits to purchase individual coverage would likely lose them because tax credits could not be calculated if each individual were charged a different premium. Like most Americans, however, you are probably insured through your job. This does not mean you are safe. The ACA provisions the Trump administration asked the court to invalidate affect all forms of private health coverage -- individual, small group, large group, and self-insured employer plans.

If the ACA is invalidated, protections under the prior law, the Health Insurance Portability and Accountability Act, would likely come back into force. Under that law, they would prohibit your employer from refusing to cover you or charging you more because of a preexisting condition, but your employer plan could refuse to cover preexisting conditions for up to a year if you failed to maintain continuous coverage.

Insurers could once again refuse to cover large groups and could charge small groups higher premiums based on health status, age, and gender. Group premiums would also likely increase as high-cost individuals no longer insurable in the individual market sought employer coverage.

The greatest impact on individuals with employer coverage, if Judge O'Connor adopts the Trump administration's position, however, would be that it would lock them once again into their jobs. Anyone with a preexisting condition who lost or left a job -- perhaps to pursue an opportunity in the gig economy --might not be able to find affordable coverage in the individual market or insurance that covered preexisting conditions.

Similarly, Medicaid beneficiaries with preexisting conditions whose income increased might find themselves losing Medicaid and unable to find affordable individual market coverage. Adult children with preexisting conditions who reached age 26 and lost parental coverage might be unable to find affordable insurance if they couldn't find jobs that offer health coverage.

Responding to the Trump administration's brief, Senate Majority Leader McConnell said on July 12, "Everybody I know in the Senate -- everybody -- is in favor of maintaining coverage for pre-existing conditions."

Indiana Coronavirus Cases

Data is updated nightly.

Cases: 1084488

Reported Deaths: 17386
CountyCasesDeaths
Marion1425562217
Lake705171220
Allen64347862
Hamilton49481481
St. Joseph48135639
Elkhart39011536
Vanderburgh33874494
Tippecanoe29863271
Johnson26876463
Hendricks25548379
Porter24683380
Madison20440444
Clark19785275
Vigo18609308
LaPorte16638260
Monroe16237217
Delaware16230286
Howard16181310
Kosciusko13763162
Hancock12644184
Bartholomew12544188
Warrick11889189
Wayne11794264
Floyd11792225
Grant11484233
Morgan10134188
Boone9576120
Noble8921121
Henry8917163
Marshall8792146
Dearborn875798
Dubois8673138
Shelby7958127
Cass7907126
Lawrence7861182
DeKalb7416106
Jackson738093
Huntington7280107
Gibson6922118
Montgomery6830122
Harrison680696
Knox6779113
Steuben641185
Miami6384106
Whitley631160
Putnam626582
Clinton614176
Wabash5958108
Jasper591991
Jefferson5617102
Ripley540892
Adams527881
Daviess4964116
Scott475978
Wells462998
White459967
Greene458399
Clay452162
Decatur4491109
Jennings434666
Fayette429094
LaGrange413890
Posey398344
Washington380654
Randolph3770107
Fountain364962
Spencer353446
Fulton352270
Starke343672
Sullivan342454
Owen341676
Orange320270
Jay315450
Rush293332
Carroll287037
Franklin283544
Perry281453
Vermillion277557
Parke244930
Tipton244664
Pike241744
Blackford213944
Pulaski203158
Newton176552
Brown169850
Crawford167129
Benton160517
Martin149219
Switzerland143712
Warren131416
Union115416
Ohio90513
Unassigned0581

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 1673496

Reported Deaths: 26483
CountyCasesDeaths
Franklin1757641826
Cuyahoga1629012636
Hamilton1118741528
Montgomery791421387
Summit697231199
Lucas615331017
Butler55597803
Stark521611170
Lorain40661639
Warren35239412
Mahoning34821769
Lake31171493
Clermont30541362
Delaware26553182
Trumbull26366611
Licking26095335
Medina25072351
Fairfield24063287
Greene23957369
Clark21542387
Portage20538280
Richland20465336
Wood19524246
Allen18427320
Miami16950348
Columbiana16385331
Muskingum16346206
Wayne15351304
Tuscarawas14018357
Marion12978194
Erie12350198
Ashtabula12171225
Scioto12166182
Pickaway12009151
Ross11417223
Hancock11151173
Geauga10572174
Lawrence10433171
Belmont10200231
Huron9545155
Jefferson9425225
Union933375
Sandusky8981166
Seneca8639156
Knox8591169
Washington8578156
Athens825096
Darke8215179
Ashland7777147
Auglaize7695115
Shelby7302132
Defiance7174114
Brown7015115
Crawford7010150
Fulton6953111
Logan6818108
Mercer679397
Guernsey677983
Highland6591117
Madison639289
Clinton6361106
Williams623498
Preble6153139
Putnam6054120
Jackson569496
Champaign564786
Perry557179
Coshocton5525103
Ottawa549599
Morrow504464
Fayette481270
Hardin475399
Gallia460278
Pike457876
Van Wert451591
Adams4495109
Henry422776
Hocking398093
Holmes3917137
Wyandot366673
Carroll348978
Paulding317449
Meigs300957
Monroe230860
Noble216147
Morgan208938
Harrison204052
Vinton182037
Unassigned05
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