Health Insurance for Pre-Existing Illnesses Is at Stake
People with pre-existing medical conditions could lose their individual health coverage if a judge rules in favor of the 20 states that are currently suing the federal government over the constitutionality of the Affordable Care Act.
And the Trump administration extended a helping hand to them, because the Justice Department refused to defend the law and pre-existing conditions in court – an “ unusual ” move that could affect millions of people.
Last year, during the GOP’s attempt to repeal the ACA, the potential loss of health coverage for people with pre-existing medical conditions and disabilities was one of the most powerful rallying forces against abolition. Voters across the country have said they will not go back to the days when they could be charged more for conditions like high blood pressure or asthma, or were completely denied coverage if they were battling cancer. Republicans, including President Trump , have vowed time and time again that the remedies are safe.
But promises in politics are short-lived. Now, less than a year later, guaranteed coverage for people in the individual market is again at stake thanks to the Trump administration’s inaction (the Justice Department actually filed a statement in support of conservative states’ claims that remedies are unconstitutional). … “By reneging on legal protections in court, the Trump administration says it no longer supports these consumer protection measures,” reports NPR . The administration has argued that other parts of the ACA, such as the Medicaid extension, are unconstitutional.
Denmark Palanker, associate professor at the Georgetown Center for Health Insurance Reform, writes in an email that the Trump administration’s stance on the case is “extremely serious.”
“The Trump administration is trying to end the persecution around Congress by encouraging the courts to overturn pre-existing protections that Congress has chosen to keep as law,” she writes. “If the courts side with the administration, there could be chaos in the health insurance markets.”
This is because the individual market is likely to go back to the pre-ACA days, when patients were usually denied coverage for chronic conditions and diseases, and women paid more for insurance based on their gender.
Sick people lose coverage
According to the Kaiser Family Foundation , 27 percent of adults under the age of 65 in the individual market have a pre-existing medical condition that could exclude their insurance coverage if the ACA or its community rating clause is canceled. The Department of Health and Human Services estimates that 133 million non-elderly Americans have a condition that could render them uninsured or incur “exorbitant” costs if protection disappears.
As Larry Levitt, senior vice president of Kaiser explains , “18 percent of individual insurance claimants were denied coverage prior to the ACA. Others didn’t even bother to apply because they knew they already had conditions that made them uninsured. ” Still others were provided with coverage that did not include treatment for their conditions.
And it’s not just life-threatening conditions like cancer or kidney disease that can get in your way, even though that would be egregious enough. Eating disorders, acne, obesity, sleep apnea and mental illnesses such as depression were used as reasons for denying insurance just a few years ago. Transgender people have been denied as well, as have people with specific careers, including window cleaners, taxi drivers and pilots.
Removing these protections also “opens the door for insurance company abuses, such as recessions, to search for undisclosed medical records that may justify denial of claims, even if the undisclosed terms have nothing to do with the claim,” according to the Los Angeles Times .
In this insurance claim tweeted by Levitt, you can see what insurers have been looking for.
Women will pay more based on gender
Before the ACA went into effect, it was common practice to have a gender rating, whereby women were charged higher fees for the same coverage as men. Health insurance premiums for women are often 1.5 times higher than those for men.
But discrimination has gone beyond that: Caesarean section and a history of domestic violence have been used as an excuse to deny coverage (important to note that women are not the only victims of domestic violence, but more women than men are victims), and pregnancy – including just being able to get pregnant was considered a pre-existing condition. Often times, women would need to purchase a maternity rider for an additional fee if they wanted coverage.
Young people will pay less premiums
By excluding the sickest Americans, younger, healthier people will receive lower premiums until they get sick. This is because insurers will be able to cancel coverage at the end of the year if you are diagnosed with a medical condition or have any other health problems that you need coverage to solve.
On the other hand, older people will face higher costs or be excluded from the market altogether.
Whether the states win the lawsuit or not, insurers are using uncertainty to drive up next year’s premiums . While many people in the individual market are eligible for subsidies that lower their costs, some do not – and they are already paying the price.