By Sabrina Corlette, Maanasa Kona, and Justin Giovannelli

The Affordable Care Act (ACA) has been polarizing, but its provisions designed to help people obtain coverage regardless of health status are consistently popular. Nevertheless, ACA opponents continue to target the law’s pre-existing condition protections. On September 5, a federal district court in Texas will hear arguments in a lawsuit filed by Republican governors and attorneys general in 20 states that seeks to invalidate these and other ACA provisions. The U.S. Department of Justice (DOJ) has weighed in, largely agreeing with the plaintiff states that the ACA’s pre-existing condition provisions should be struck down.

Should the court rule in the plaintiffs’ and DOJ’s favor, the impact of its decision will be felt differently from state to state. In CHIR’s latest post for The Commonwealth Fund’s To the Point blog, we conducted a comprehensive review of insurance statutes in 50 states and the District of Columbia. We found that most states have not fully incorporated the ACA’s guaranteed issue, preexisting condition exclusion, and community rating standards into state law. Specifically,

• Four states (Colorado, Massachusetts, New York, and Virginia) have adopted all three ACA or equivalent protections.
• Fourteen states have partially adopted the suite of ACA preexisting condition protections, meaning that consumers in those states could face some gaps in coverage access and affordability. For example, Delaware law requires insurers to issue policies to consumers regardless of health status, but insurers would be permitted to impose preexisting condition exclusions if the ACA provision is struck down.
• Nine states and D.C. adopted one or more of the ACA’s preexisting condition protections but include provisions that render the state law protection void in the event the corresponding ACA provisions are repealed or invalidated.
• Twenty-nine states have not adopted any of the ACA consumer protections. Many of these states are also plaintiffs in the litigation.

For a full review of state pre-existing condition protection laws, see our post here.