Trump Administration Move Imperils Pre-Existing Condition Protections

Tuesday, 12 Jun, 2018

The Department of Justice said Thursday that it will not defend the constitutionality of key provisions of the Affordable Care Act in a lawsuit now underway in Texas. HHS and Treasury administer the health law's coverage and subsidies.

The argument evokes Chief Justice John G. Roberts Jr.'s 2012 ruling upholding the constitutionality of the individual mandate as a valid use of Congress's taxing power.

After failing to repeal the Affordable Care Act with a Republican-controlled Congress, the Trump administration is seizing on a different strategy for dismantling the law, one fraught with political risk.

And though the federal government will apparently no longer defend a pillar of the law, a group of left-leaning states have stepped in to back it in court.

While Justice Department attorneys often advocate for laws they may personally disagree with, those three civil servants instead chose to exit from the case, which Bagley described as "almost unheard of". So, the pre-existing condition protections are likely to stay in place during that period.

"I'm running for Congress because previous year, during the lead up to my son's birth, our doctor told my wife and I that our son may not survive or have a serious health condition for the rest of his life", Kim said Friday.

Congressional Republicans, who unsuccessfully sought to undo President Barack Obama's signature health care law throughout 2017, added language to the GOP tax bill that ended the controversial tax penalty for those who fail to obtain health care coverage.

This is not the first move the Trump administration has taken that would undermine Obamacare's consumer protections.

The two provisions, along with Obamacare's requirement that insurers offer comprehensive coverage, have been targets of Republicans seeking to repeal the law and lower premiums.

As many as 130 million adults under age 65 in the USA have pre-existing conditions that could result in their not being able to get insurance coverage in the private market, according to the Department of Health and Human Services.

Republicans seem determined not only to make American health care more inefficient and cruel in every way they can think of, but to do it while making themselves as unpopular as possible.

The District of Columbia and 32 states have opted to expand Medicaid eligibility under the ACA to nonelderly adults with incomes up to 138% of poverty level; several other states are considering expansion. Why it matters: Protections for people with pre-existing conditions are hugely popular, and the administration may have handed Democrats their strongest health care weapon yet - because now they can make the case that the administration has gone to court to take away protections for people with pre-existing medical conditions. "Their job is to defend federal programs", Bagley says, noting that he has not talked with any of them about the case.

You may remember that the Obama team was anxious about the interaction between the individual mandate and the popular ACA provisions that say insurance companies can't refuse to cover anybody because of pre-existing conditions and can't charge you more if you are already sick. "Our coalition of states and partners across the country will fight any effort to strip families of their health insurance", he said.

The ACA is a package made up of two separate laws: the Patient Protection and Affordable Care Act of 2010 (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA).

But the move also upends a longstanding legal and democratic norm that the executive branch will uphold existing laws.

"The question is, what does this do to insurance markets now?" said Jost. "As of 2019, therefore, the individual mandate will be unconstitutional under controlling Supreme Court precedent holding that 'the federal government does not have the power to order people to buy health insurance, '" the brief says. "We implore you to listen to the voices of career Justice Department lawyers, as well as concerned families, patients, doctors and hospitals that want to retain these protections, and start working with Democrats to strengthen our health care system instead of trying to tear it down", the senators said in their letter to Trump.

ACA opponents argued even before the legislation creating the ACA was drafted that a mandate would be the equivalent of Congress requiring people who hate broccoli to buy broccoli. But the Department of Health and Human Services could, in theory, create exceptions to those rules or rewrite them in way that could upend coverage for some consumers midyear, Levitt said.

Attorney General Jeff Sessions said in a letter to Congress that Trump, who campaigned on repealing the law and almost did so his first year in office, approved the legal strategy.

The states' challenge to the overall ACA has been pending since February in the Fort Worth court of U.S. District Judge Reed C. O'Connor.