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National Health Care Groups Act to Support Health Care Coverage for People with Pre-existing Conditions

June 15, 2018

A group of national hospital, physician, and insurance advocacy groups are taking legal action to protect health care coverage for people with pre-existing conditions.

Under the Affordable Care Act, health insurers can’t charge more or deny coverage to people because of a pre-existing health conditions like asthma, diabetes, or cancer. They cannot limit benefits for those conditions, and they cannot refuse to cover treatment for pre-existing conditions. However, these protections are now being threatened.

In response to legal proceedings in federal court, which challenge the constitutionality of the Affordable Care Act (ACA), the group filed amicus curiae (friend-of-the-court) brief arguing that the ACA should not be struck down and pre-existing condition protections should remain.

Texas and a coalition of 19 other Republican-led states filed a lawsuit in federal court arguing that the decision of Congress to eliminate the penalty for the individual mandate, beginning during 2019, make the individual mandate unconstitutional. As a result, they argue that the consumer insurance protections under the law also are invalid.

Last week, the U.S. Department of Justice (DOJ) announced it would not defend the constitutionality of the individual mandate. DOJ argued that certain provisions, including guaranteed issue and community rating, which protect patients with pre-existing conditions, cannot be separated, and cannot stand.

National hospital advocates—led by the American Hospital Association, and joined by the Federation of American Hospitals, Catholic Health Association of the United States, and Association of American Medical Colleges—filed an amicus curiae brief. The brief warns that judicial repeal of the law would eliminate coverage gains and inflict “severe consequences for America’s hospitals which would be forced to shoulder the greater uncompensated-care burden.”

If people with pre-existing conditions cannot secure health care coverage, they will seek health care services for which they cannot pay. Hospitals will provide the care, but receive no payment, resulting in financial burdens.

Similarly, the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry argued in their brief that, "Invalidating the guaranteed-issue and community rating provisions—or the entire ACA—would have a devastating impact on doctors, patients, and the American health care system as a whole.”

The America's Health Insurance Plans (AHIP) brief cites the destabilizing consequences of repealing the ACA and pointed to “massive disruption, market chaos, and immediate short-term harms to patients, health insurance providers, and other stakeholders.”

Each of the amicus curiae briefs put forward legal arguments contesting the notion that the ACA must be struck down as a result of the repeal of the individual mandate penalty. In April, seventeen Democratic attorney’s general filed a motion to intervene in defense of the ACA.

In the wake of the announcement by the Trump Administration in support of the Texas-led lawsuit, many members of the U.S. Senate reaffirmed their support for coverage for pre-existing conditions.

The ACA has been instrumental in supporting more than 1.1 million Pennsylvanians through health insurance coverage, providing better access to health care services and dramatically reducing the uninsured population in Pennsylvania. HAP continues to promote the importance of coverage with consumers, and advocate for policies that support the goal of access to high quality care.

If you have any questions relating to this issue, and the impact of coverage, please contact Jeff Bechtel, HAP’s senior vice president, health economics and policy. Questions regarding HAP’s federal advocacy efforts should be directed to Laura Stevens Kent, HAP’s vice president, federal advocacy.

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