Denying coverage to the sick
Ieffort to undermine the Affordable Care Act — and in the process, raise premiums for millions of Americans — the Trump administration is urging a federal judge in Texas to throw out the law’s protections for people with preexisting conditions.
Last week Justice Department lawyers urged the judge to declare several parts of the Affordable Care Act unconstitutional, including the prohibitions on insurers denying coverage or charging higher rates to applicants who have, or once had, a potentially costly medical condition. Those protections had long been in place for large employer health plans; the ACA extended them to the roughly 20 million Americans who buy policies independently, including people shopping at the state Obamacare exchanges.
In essence, the administration wants to let insurers deny coverage to those most in need of it, or to charge them considerably higher premiums than they’re allowed to charge today in the Obamacare exchanges.
This is appalling. Even Republicans who’ve sought to repeal Obamacare have been reluctant to do away with protections for people with preexisting conditions — because the public supports those regulations, and unequivocally so. A Kaiser Family Foundation poll in June 2017 showed that 70% of those surveyed, including 59% of Republicans, wanted Washington to continue the protection against price discrimination.
The Justice Department’s brief is consistent with the administration’s relentless efforts to return health insurance to the bad old days when older, less healthy people — and perfectly healthy people with risky occupations or serious illnesses in their past — had trouble obtaining affordable coverage.
By depressing enrollment in the state exchanges, legalizing year-round junk insurance policies and allowing health plans with limited benefits, the administration has worked diligently to let younger, healthier people separate themselves from the rest of the market and buy cheaper, less-comprehensive policies. Those efforts are expected to drive premiums up significantly for those with preexisting conditions.
Its latest gambit came Thursday, when the Justice Department partially endorsed a lawsuit Texas and 17 other states brought against the ACA in February. The lawsuit uses as its jumping-off point the Supreme Court’s decision in 2012 that ruled the ACA’s “individual mandate” — the requirement that adult Americans carry insurance or pay a tax penalty — a valid exercise of Congress’ power to tax. Noting that Congress eliminated that tax penalty as of the end of this year, the lawsuit argues that the ACA has become unconstitutional.
The Justice Department contends that because the mandate has been rendered unenforceable, the court must throw out the ACA’s requirements that insurers accept all applicants and that they charge people with preexisting conditions no more than healthy people in the region. Otherwise, the department argues in its brief, people could “game the system by waiting until they were sick to purchase health insurance, thereby increasing the price of insurance for everyone else — the polar opposite of what Congress sought in enacting the ACA.”
The administration is right about the effect of defanging the mandate — this change alone is projected to raise 2019 premiums by 10% on average in the exchanges. But it’s outrageous to argue that the havoc Republicans wreaked upon the exchanges by neutering the individual mandate justifies doing even more harm to the people in them. It’s also ridiculous to argue that courts should repeal more of the ACA than Congress itself chose to do last year.
This is another example of the wrecking ball that is the Trump administration. The ACA has run into some real problems, particularly in states that didn’t establish their own exchanges. But rather than mitigating those problems by spreading costs more broadly, Trump (and congressional Republicans) have focused on Balkanizing the market in ways that help only the healthy.
The president is so determined to undo everything associated with his predecessor he doesn’t seem to care where the chips fall. With this latest move, the chips would fall on millions of Americans with preexisting conditions and no employer health benefits.
Open enrollment for the Obamacare exchanges begins Nov. 1, five days before the midterm elections. Although the lawsuit isn’t likely to be decided by then, analysts say the uncertainty surrounding preexisting conditions is likely to drive up premiums beyond the increase related to the end of the individual mandate penalties. How long will it take for the millions of Americans affected by these increases to recognize what’s happening to them and why?