It took a groundswell of public opinion to help persuade three Republican senators to vote with Democrats a year ago to defeat the attempt by the GOP and the Trump administration to repeal the Affordable Care Act, still widely known as Obamacare.
Since then, the Trump administration and Republicans in Congress and some states have taken a less-public track to undermine and dismantle the 2010 law and recently have moved to end what may be the law’s single-most popular provision, one that affects millions of Americans, whether they get their coverage through the ACA, through their employer or purchased on their own.
Since passage of the Affordable Care Act, insurers have been prevented from denying coverage to those with pre-existing conditions or charging higher premiums because of those maladies, such as asthma, diabetes, cancer, multiple sclerosis and many others.
Unable to repeal Obamacare in Congress, the Trump administration and Republicans have instead worked to remove its underpinnings in hope of its collapse, including withholding market stabilizing and cost-sharing payments to insurance companies that allow insurance to be provided to a range of customers, shortening the ACA’s open enrollment period and slashing support for education and outreach to encourage and assist enrollment.
So far, the ACA has not obliged. During last year’s open enrollment period, more than 11.8 million signed up for health plans through the ACA, a 3 percent decrease from the year before but not the drop many had expected.
But removal of the ACA’s protections for pre-existing conditions could be the final blow and one that would return Americans to ever-spiraling health care costs and leave millions again without coverage.
Texas and 19 other states have filed suit against the federal government, claiming that the ACA’s individual mandate requiring people to obtain health insurance is now unconstitutional, following Congress’ decision to end the tax penalty for those who do not have health insurance.
Typically the federal government is expected to defend existing laws challenged in court, but Attorney General Jeff Sessions announced in June that the Department of Justice would not defend the ACA. If the lawsuit is successful, the court decision would likely render unconstitutional the ACA’s provision on pre-existing conditions along with others.
About 133 million Americans younger than 65 — about 51 percent of that population — are believed to live with pre-existing conditions, according to a fact sheet from the Department of Health and Human Services. In Washington state, about 3 million — 41 percent of those under 65 — have pre-existing conditions, as do some 385,000 of children under 18 in the state.
The Kaiser Family Foundation’s Health Tracking Poll for June found support among 9 in 10 Americans polled, with 76 percent considering it “very important” that the ACA’s provision on pre-existing conditions remain law, while another 15 percent said it was “somewhat important.” Only 8 percent said that protecting the provision was “not too important” or “not at all important.”
The attack on the ACA and its protections for those with pre-existing conditions prompted a roundtable discussion among doctors, patients and health care advocates last Sunday at Providence Everett Medical Center’s Colby campus with U.S. Sen. Maria Cantwell, D-Washington.
Among them, as reported Monday by The Herald’s Ben Watanabe:
Holly Hill of Renton, who was diagnosed with multiple sclerosis at age 20, said that before passage of the ACA she struggled to find coverage and feared the loss of coverage for medications that costs about $5,000 a month.
Joe Sauter of Shoreline, whose teenage son lives with hemophilia, said the ACA has helped his family afford equally costly medications that prevent bleeding in his son’s joints and have allowed him to live a relatively normal life and even run for his high school cross-country team.
A “return to the bad old days,” Hill and Sauter agreed, would force them back into the shadows, afraid that even talking about the medical conditions could leave them open to losing what coverage they had.
Jim Bloss, an advocate with National Alliance for Mental Illness Snohomish County and the father of an adult child with mental illness, warned that for those with mental illness, loss of coverage “would be a death sentence,” as untreated mental illnesses can reduce life spans by 25 years or more.
The end of the ACA’s protections for pre-existing conditions, Bloss said, would have far-reaching effects for communities, because those unable to afford medications are likely to become unstable, return to the streets and again fill up jails and prisons.
The ACA also has benefited those fortunate enough that they or a family member don’t have a pre-existing condition, by helping to control costs of health care and insurance premiums.
While increases have continued, they had been less severe until recently. Even the insurance companies, themselves, have advocated for the ACA’s protections of pre-existing conditions.
“Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” the trade association for health insurance companies, America’s Health Insurance Plans, said in June.
At the same time, the Trump administration’s decision to pull the ACA’s payments to insurers also have caused uncertainty for the markets, with a resulting increase last year in premium costs for millions of Americans and small businesses and a larger increase expected later this year.
Even with strong public support for the ACA’s protections for those with pre-existing conditions, Cantwell agreed that the threat to those protections from the lawsuit and the actions of the Trump administration may not be widely understood, with some assuming that the GOP failure to end Obamacare last year had settled the issue.
Those who know the ACA’s protections are valuable to themselves, their families and their communities will again need to speak up. This year’s elections offer a good opportunity to do so.