The short answer: everyone. Whether you currently don’t have health insurance but may wish to buy it some day; you purchase insurance through the Affordable Care Act (ACA) Marketplace; are on Medicare or Medicaid; or have employer-sponsored health insurance, pre-existing conditions protections may become a relic of the past if the U.S. Supreme Court rules against upholding the ACA. The U.S. Department of Health and Human Services estimates that as few as 61 million, or as many as 133 million people have pre-existing conditions.
The slightly longer answer: everyone, and COVID-19 has only heightened the importance of pre-existing conditions coverage. The virus has left a trail of damage to the lungs, heart, and brain among the nearly eight million people who’ve contracted it in the United States. Pandemic worry and stress has also caused a dramatic increase in symptoms of diagnosable mental health problems, from 11 percent pre-COVID-19, to 40 percent, according to a Kaiser Family Foundation analysis of NHIS and Census Bureau Survey data. Without the ACA, the list of pre-existing conditions could include all of these conditions and more.
Another group that is especially vulnerable if pre-existing conditions coverage goes away consists of those who’ve lost health insurance due to COVID-19-related job losses. Without pre-existing conditions provisions, their efforts to get back into the health insurance market could be flat-out denied by insurers or face unaffordably high premiums. The number of people who’ve lost employer-based coverage is a changing, moving number, but a recent study sponsored by three research institutions estimates 14.6 million people are affected by a job loss that also provided health insurance.
Exactly what does pre-existing conditions coverage provide?
Under the ACA, insurers cannot deny coverage due to a pre-existing condition, AND you cannot be charged more than someone in the same age group as you for coverage.
Additionally, because the ACA establishes essential health benefits, insurers can’t exclude paying for things such as mental health treatment or rehabilitation services to recover mental and physical skills.
The ACA also prohibits insurers from imposing annual or lifetime limits on covered benefits. People with chronic or expensive to treat illnesses would be saddled with astronomical bills without this protection. For example, “when a baby is born with a congenital defect, sometimes the child will have millions of dollars in care within the first one or two years of life,” says Dania Palanker with Georgetown University’s Health Policy Institute.
Despite its popularity, pre-existing conditions coverage is on President Trump’s chopping block
The pre-existing conditions provisions of the ACA are extremely popular, with a clear majority of Republicans, Democrats, and Independents saying it is very important to keep them in place. President Trump has repeatedly said he’ll keep pre-existing conditions coverage, and he recently issued an executive order vowing support. However, as his top health officials acknowledged, the order has no enforcement mechanism. Congressional action, not an executive order, is needed to enact health care policy with the force of law. Republican legislators have consistently opposed meaningful reform, as even Trump called their 2017 health care proposal “mean.”
Strong on rhetoric and weak on policy, Trump’s actions reveal a forceful trajectory toward obliterating the ACA while neglecting to offer the robust alternative he has boasted about in extremely vague terms over the past four years.
Asks the U.S. Supreme Court to overturn entire ACA
The case currently challenging the ACA is scheduled for November 10thbefore the Supreme Court. The court will decide whether a lower court ruling invalidating the entire ACA should be upheld or not. At first the Trump administration supported keeping portions of the ACA, but later changed its position and had its Justice Department side with toppling it all – including pre-existing conditions.
At first the Trump administration supported keeping portions of the ACA, but later changed its position and had its Justice Department side with toppling it all – including pre-existing conditions.
While Trump’s supporters believe he wouldn’t allow pre-existing conditions protections to become history, a review of what he has already done provides a glimpse at what a non-ACA health landscape could look like.
Short-term health plans = junk
President Trump has lengthened the period of time that insurers can offer “short-term” health insurance plans up to three years. These plans were originally intended to cover temporary gaps in coverage, such as when someone was transitioning from one plan but not yet eligible for another. These plans:
- Do not require covering pre-existing conditions;
- Do not prohibit insurers from excluding certain illnesses or charging more for coverage. In fact, insurers can cancel your plan just at the moment when you become sick, citing your condition as pre-existing;
- Do not prohibit a total dollar cap on what the insurer will pay.
These health plans are marketed as a cheaper alternative, while downplaying the reality that when someone on this type of plan actually needs coverage, they’d find they had very little to cushion them from financial ruin. Health analysts often refer to these plans as “junk.”
Turning up rhetoric volume and delivering little
President Trump seems to understand that pre-existing conditions coverage is popular with his voters and he continues saying that he supports it. But just as he rates his handling of the coronavirus as a “10,” his tweets and rally speeches saying he favors keeping pre-existing conditions coverage won’t make it so. If the Supreme Court rules to eliminate the ACA as the Trump administration supports, the health care system will be plunged into chaos without an alternative yet available even to debate.
