Pre-Existing Conditions: Protecting Access to Care

At 19, Jen was diagnosed with Lupus. She had to navigate her way into adulthood balancing doctors’ visits and frequent prescription refills. Jen knew health insurance was critical for managing her chronic disease, but never more so than when she became pregnant with her first child. Her diagnosis meant additional pre- and post-natal care to support the health of her baby. Fortunately, the Affordable Care Act’s (ACA) guaranteed coverage for anyone with a pre-existing condition, like Lupus, required Jen’s health insurer to cover her and her child’s care.

Thanks to the ACA 130 million Americans with pre-existing conditions can no longer be discriminated against when it comes to health care coverage. Despite this success, President Trump and Republican leadership on Capitol Hill have started taking an axe to this vital provision of the ACA. In June, Attorney General Jeff Sessions announced that the Department of Justice would no longer defend coverage for pre-existing conditions in Texas v. United States, a court case brought by Republican-led states arguing that the guaranteed issue provision of the ACA is unconstitutional.

The Trump administration’s decision not to defend the law has a devastating effect: millions of Americans with pre-existing conditions could be unable to access health insurance. It could also sabotage the health care system as a whole.

Reacting to the administration’s announcement that they would not defend protections for those with pre-existing conditions, Matt Eyles, President of America’s Health Insurance Plans (AHIP) said, “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.”

As many as half of all Americans have an illness or condition that is considered a pre-existing condition by insurance companies. That’s one in every two Americans who rely on non-discriminatory care from their insurer to cover everything from asthma, to diabetes, to cancer, to mental health, to substance use disorder. For older Americans, the percentage is even higher: about 86 percent of Americans between the ages of 55 and 64 have at least one pre-existing condition, according to government estimates.

Yet another astounding fact is that prior to the ACA, being a woman was considered a pre-existing condition, allowing insurers to deny coverage to women or charge women more for coverage. A recent study found that nearly 68 million women and girls nationwide have a pre-existing condition, including the 6 million pregnancies that occur each year in the United States.

The reality is this that at one point or another we all experience a health scare and there is little planning that can prepare any of us for the heartache of a medical emergency. But what we can prevent is a family bankruptcy when someone gets sick. This risk is significantly reduced when health insurance providers can’t use our health conditions to prevent us from accessing care or charge us additional out-of-pocket expenses. But we can’t achieve this if the Trump administration and a Republican-led Congress continue to dismantle policies that are working for the American people.

Unfortunately, attacking Americans’ basic right to health care isn’t a new play for the Republican leadership. Just last summer, House Republicans voted to repeal the ACA in its entirety, but were thankfully stopped by the U.S. Senate. More recently, the Republican tax bill, a significant giveaway to the wealthiest corporations, added $2 trillion to our deficit. To balance the cost, my Republican colleagues are now proposing cuts to Social Security, Medicare, and Medicaid – benefits that hardworking Americans have earned.

Every American family should be able to access health insurance that is reliable and affordable. We must also lower prescription drug costs, lower premiums and deductibles, protect Medicare and Social Security, and defend coverage for pre-existing conditions. We know that the security of the American family starts with the ability to access affordable, quality health care, and I will never stop fighting until health care is a right for all, rather than a privilege for a few.

Katherine Clark represents Revere in the United States Congress.

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