Removal of Pre-existing Conditions provision of the Affordable Care Act: What will happen to the healthcare of America?

This is a guest post by Dr. Jacqueline J. Hill, Associate Dean of Nursing and Allied Health at Southern University and A & M College. Her involvement and advocacy in healthcare and educational issues spans over 20 years. 

As you may remember, in 2010 the Affordable Care Act (ACA) or as it’s known Obamacare, was signed into law by President Barack Obama. Of the various provisions included in the Act, one of the more popular provisions was the coverage of pre-existing conditions. That’s the provision that prevents insurance companies from denying coverage for a condition the person had before they tried to get insurance. 

Even with the repeal and replace movement of the ACA by the Trump administration, removal of the pre-existing provision was not one of the changes proposed.  In November 2016, the Kaiser Family Foundation conducted its health tracking poll to determine if healthcare was a major factor in the presidential election. The survey found that many of the law’s major provisions (e.g., health coverage for 26-year olds and pre-existing conditions) were quite popular, even across party lines –which begs the question, “why would President Trump want to overturn the pre-existing provision of the ACA?”

Initially, I thought this effort was driven by the insurance industry, but after further investigation, my findings revealed that was not the case. It seems that America’s Health Insurance Plans (AHIP), the trade association for health insurance companies, supports the pre-existing condition protections under the ACA. According to AHIP “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,” They plan to file an amicus brief to support the ACA law. 

So if insurance companies are supporting it, what’s pushing the movement?  Apparently, a lawsuit was filed by 20 states in February 2017 challenging the constitutionality of the individual mandate. Despite the Supreme Court’s ruling earlier this year on the individual mandate, the Republican tax bill eliminates the penalty for not buying insurance, which goes into effect in 2019.  To put it simply, the individual mandate is the part of the law that required everyone to have health insurance. The attorney general of Texas, Ken Paxton, asserts that without the individual mandate, which is the cornerstone of the ACA, the ACA is unconstitutional.

If the courts are in agreement with him then that means that persons with pre-existing conditions would be subject to the pre-ACA era of insurance companies denying them insurance coverage. Unfortunately, the Justice Department has refused to defend the ACA law and are leaving it to the courts.

According to Health and Human Services, approximately 130 million people in US under 65 years of age have pre-existing conditions.  We all know someone who was denied insurance or could not afford the exorbitant cost of insurance for having a pre-existing condition, e.g., diabetes, hypertension, etc. prior to the implementation of the ACA.

Recognizing the role that the ACA has played in assisting people who were previously unable to be insured justifies the importance of maintaining the pre-existing component of the ACA. 

So, what should we as citizens do? We should write our legislators and implore them to not allow this to occur. Recommend that they not tamper with the pre-existing provision, since removing it will negatively impact so many Americans.

Additionally, we should inform key stakeholders such as the insurance companies, nursing associations, and other grassroots organizations and voice our support of the pre-existing provision.  As noted earlier, it’s one of the provisions that most people agree is a good one. What we don’t want to occur is go backwards to a time when so many were not afforded insurance.

Dr. Jacqueline J. Hill is Associate Dean of Nursing and Allied Health at Southern University and A & M College. Her involvement and advocacy in healthcare and educational issues spans over 20 years.