Currently the Affordable Care Act (ACA) protects people with pre-existing conditions by outlawing health insurance companies from refusing to sell plans to individuals because of existing health issues. These protections are particularly important for older Americans who obviously are more likely to have a pre-existing condition. Unfortunately, these protections could be compromised by Department of Justice’s (DOJ) decision not to defend the ACA’s in a lawsuit brought by Texas and 19 other states. The basic premise behind the litigation is that because of last year’s tax reform legislation, the individual mandate has been effectively eliminated because people will no longer be taxed for not carrying health insurance. Taken one step further, these 20 states argue that because the individual mandate is so integral to the ACA, that the rest of the legislation should be found unconstitutional (it should be noted the administration is only arguing pre-existing protections and community ratings should be found invalid). Currently around 25 million older Americans (50 to 64) could be denied insurance in the individual market if the protections for people with pre-existing health conditions are eliminated.   

First the DOJ’s  decision is concerning because it runs contrary to its own long standing tradition of generally defending federal law in litigation, even if the current administration is ideologically opposed to the policy. Law professor Nicholas Bagley from the University of Michigan who used to work at the DOJ said, “I am at a loss for words to explain how big of a deal this is. The Justice Department has a durable, long-standing, bipartisan commitment to defending the law when non-frivolous arguments can be made in its defense. This brief torches that commitment.”

In addition, in a letter from Attorney General Jeff Sessions to House Speaker Paul Ryan regarding this litigation, Sessions argues that without the individual mandate, “individuals could wait until they become sick to purchase insurance, thus driving up premiums for everyone else.” Meaning people could go without insurance until they become sick, and because of pre-existing conditions protections insurance companies would be forced to sell sick people policies, thus driving up the costs for everyone else. If I understand this correctly, Congress and the White House repeal the individual mandate, which will likely drive up health insurance premiums, and their solution to this problem is to deny protections for people with pre-existing conditions. 

While a final resolution regarding this litigation is a ways off, currently the ACA has been instrumental in providing improved health care protection and coverage for older Americans. For example, according to the Commonwealth Fund in 2010, 43 percent of individuals between the ages of 50 to 64 who attempted to purchase health care coverage where either rejected, charged higher premiums or had certain health conditions omitted from policies. The ACA combats these problems by not allowing people to be denied for pre-existing conditions, limiting what insurance companies can charge older Americans compared to younger people and regulating individual’s insurance premiums through tax credits. The Commonwealth Fund reports between 2012 to 2016 older Americans between 50 and 64 saw the uninsured rate drop from 13 to 8 percent. Clearly older Americans have seen substantial improvements in health insurance access since the ACA was enacted; eliminating protections for pre-existing conditions will inevitably cause older adults health care costs to increase.

Furthermore, as I have reported in my previous blog, Repealing and Replacing The Affordable Care Act And Its Impact on Medicare, older Americans who don’t have health insurance prior to turning 65 are more likely to require more expensive health care once they enroll in Medicare.  The Justice Department’s decision not to defend pre-existing conditions in litigation will only make older adults less healthy before they enroll in Medicare by potentially limiting access to health insurance.  

Lastly, this litigation flies in the face of public opinion. According to a Kaiser Family Foundation poll, support for pre-existing protections is solid across the political spectrum with support amongst 84 percent of Democrats, 68 percent of Independents and 59 percent of Republicans.

Thankfully, the ACA is still standing and our elected officials in Washington, D.C. have been unable to repeal and replace the ACA. Realizing that a legislative repeal of the ACA might be unworkable, everything has been done to weaken this legislation. The administration has drastically reduced the ACA’s advertising budget, eliminated the cost-sharing subsidies and expanded short-term health plans which don’t offer key ACA protections.

Sadly, the current lawsuit’s end result could potentially strip away basic health care protections for older Americans. What happens if the court sides with the plaintiffs and gets rid of pre-existing conditions protections? Are older Americans expected to go back to a health care system where their plans are more expensive and protections are less stringent? Let’s hope for the sake of all Americans our court system protects safeguards put in place by the ACA for people with pre-existing protections.