Texas Court Ruling Throws Future of ACA’s Pre-existing Condition Protections, Coverage Gains into Doubt

The news broke on a Friday, on the eve of the final day of the Affordable Care Act’s (ACA) open enrollment period, typically one of the highest-traffic days for the health insurance marketplaces. A federal district court judge in Texas declared the entire ACA unconstitutional. The implications of the decision are sweeping, potentially affecting approximately 18 percent of the U.S. economy. The judge’s ruling struck down not just well-known provisions of the ACA, such as the provisions enabling people with pre-existing conditions to obtain comprehensive health insurance and the funding for Medicaid expansion, but also lesser known provisions to reform how hospitals are paid, cover preventive services for Medicare beneficiaries, and require employers to provide reasonable break time and private space for new mothers to pump breast milk.

The judge’s ruling does not stop the government from carrying out the law, and the Trump administration announced over the weekend that they would continue to do so. Further, legal experts on both sides of the political spectrum argue the judge’s decision is on shaky legal ground and predict that it will be reversed on appeal. However, as the case wends its way through the courts, the companies who provide and deliver health care services are faced with the prospect of market chaos and upheaval if the judge’s ruling is allowed to stand. More importantly, the millions of consumers and patients who have come to rely on the ACA’s protections could lose their coverage and the access to services and financial security that comes with it. Indeed, an estimated 17.1 million people would lose their insurance if this ruling is upheld.

In this space we typically write about private health insurance and health care markets. Without a doubt, insurance companies face considerable uncertainty in the wake of the judge’s decision. This uncertainty could affect their decisions about whether to continue to offer coverage in the ACA’s marketplaces and how to set premiums for their policies. CHIR will be writing about the impact of the litigation on the private insurance markets in the weeks and months to come. But today we want to highlight what the ACA has meant for the consumers and families for whom the law has been a literal lifeline, people such as:

  • Adrianne Gunter, whose life was upended by a MS diagnosis shortly after graduating from college. Prior to the ACA, no insurance company would have covered her, and as a single adult, she couldn’t qualify for her state Medicaid’s program. Thanks to the ACA, she was able to get Medicaid coverage and begin treatment for her MS, leading to the remission of some of her symptoms.
  • Timmy Morrison, delivered via emergency C-section weighing just 3 pounds, 9 ounces. His care in the NICU totaled over $2 million. Prior to the ACA, the annual limit on his parents’ plan was $1 million. Thanks to the ACA, Timmy was able to get the care he needed, the insurance company paid the bills, and his parents were saved from medical bankruptcy.
  • Abby S., who was born with a congenital disease that required multiple surgeries when she was in her teens, as well as regular monitoring and care. In college, she faced the prospect of being dropped from her parents’ health plan. However, thanks to the ACA, she was able to stay on that plan until she turned 26. She’s now covered on an employer’s plan, and the ACA’s cap on annual out-of-pocket costs and the ban on annual and lifetime limits ensures she can get the care she needs while remaining financially secure.
  • Alex Andrews, who was shot in the throat from a bullet that came in through his kitchen window. After four surgeries, he faced $500,000 in hospital bills. But thanks to the ACA and the fact that his state had expanded Medicaid, he was able to get coverage for his surgeries and post-operative care.

For these individuals, and the thousands like them, we at CHIR are hoping that saner legal minds prevail and this Texas judge’s ruling is thrown out, quickly and decisively.

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