Local politicians, health leaders concerned with access to care

Simon Moss
June 11, 2018

Department of Financial Services Superintendent Maria Vullo, the state's top health insurance regulator, wrote in a Crain's op-ed last month that she would not let the uncertainty stemming from the Trump administration's actions on the ACA lead to an increase in premiums. The brief says that part of the law can't be severed from the mandate.

"Congress is always free to amend its statutes, even to omit what it previously thought was essential", writes Nick Bagley, a law professor at the University of MI, in a Thursday evening blog post. No one in CT - or anywhere - should have to fear that they or their loved ones will be kicked to the curb and refused care when they need it most. "It suggests that future administrations can pick and choose which laws they're going to enforce", he said.

Rep. Leonard Lance, New Jersey Republican, said he wasn't up to speed on the new case but he's hopes it will not force Congress to scramble for fixes.

Moreover, if the Trump administration did not want to defend the ACA expressly, it could simply have filed a jurisdictional motion, asserting that the states are not injured by the lack of an individual mandate penalty and that the litigation is not yet timely, as the tax is still in effect.

Maine Gov. Paul LePage signed his name onto the 20-state lawsuit as one of the plaintiffs in the case that, if successful, would gut pre-existing condition protections enshrined in the Affordable Care Act.

If the court takes that action, "the ACA's provisions containing the individual mandate as well as the guaranteed-issue and community-rating requirements will all be invalid beginning on January 1, 2019", the department lawyers write in a memorandum addressed to the court. These include a "ban on insurers denying coverage and charging higher rates to people with pre-existing health conditions".

In that scenario, other ACA provisions would stay in place. As much as president Trump may dominate the headlines, the increasing cost of care is weighing heavily on voters.

"You can't pull the rug out from underneath people with pre-existing conditions", O'Donnell said. It will also make it more likely that they take back the White House in two years. "The ACA is the law of the land and DOJ should defend it". While it is uncommon for the Justice Department to go against federal law, Attorney General Jeff Sessions said that he acted with the "approval of the President of the United States".

Sen. Susan Collins, R-Maine, who voted against the Republican repeal bills in the Senate previous year, also expressed concern about the administration's new push, saying it "creates further uncertainty that could ultimately result in higher costs for millions of Americans and undermine essential protections for people with pre-existing conditions, such as asthma, cancer, heart disease, arthritis and diabetes".

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More than one in four adults younger than 65 have pre-existing medical conditions, according to the Kaiser Family Foundation.

Before the Affordable Care Act marketplace launched in 2014, people with chronic diseases who tried to buy their own insurance were routinely denied coverage based on their medical history.

The practical impact of the move may be relatively minor, as the challenge is widely viewed as a long shot that stands little chance of threatening the 2010 law, often called Obamacare. States such as California will take up the law's defense, and the legal battle will continue.

The administration's legal brief, filed Thursday in federal district court in Fort Worth, Texas, takes aim at those links.

Both of these types of policies are expected to have lower premiums, but would cover fewer benefits - making them more attractive to healthier Americans who don't need comprehensive coverage.

Defenders of Obamacare view this move by the Republicans as just the latest in a plot to undermine the monumental legislation however they can since they lack the necessary votes in Congress to repeal it officially. "The brief filed by the Trump Administration yesterday represents a shocking break from precedent, and relies on legally dubious, partisan claims to argue against the constitutionality of the current law", they said in a joint statement.

The president last fall ended "cost-sharing reduction payments" to insurers that offset discounts that the law promises to lower-income customers in the out-of-pocket costs for ACA health plans. Without the mandate, it said the law's consumer protections for people with preexisting conditions can not stand. "These are civil servants".

The Justice Department legal position nevertheless signals a remarkable willingness by the Trump administration to abandon landmark consumer protections in the health care law that for the first time prohibit health insurers from turning away sick consumers.

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