Trump Administration Again Takes Aim at Pre-Existing Conditions

  

Even as individual states take steps to expand health coverage, the Trump administration continues its misguided approach to restricting access to care. The U.S. Department of Justice (DOJ) on Thursday June 7th filed a brief in U.S. District Court in the case of Texas v. United States which indicates that the government will no longer defend the constitutionality of the Affordable Care Act’s (ACA) guaranteed issue and community rating provisions, which protect the ability of the estimated 52 million Americans with pre-existing conditions, such as diabetes and arthritis, to purchase health insurance coverage. These provisions require private health insurance providers to offer coverage to Americans with pre-existing conditions and prohibit them from charging higher premiums based on an individual’s pre-existing condition(s). They are also some of the most popular provisions of the health law, with 75 percent of Democrats and 63 percent of Republicans in support.

These crucial provisions have made it possible for some Americans with pre-existing conditions to purchase health insurance coverage for the first time and have contributed to the decline in the percentage of Americans who are uninsured. In the unlikely event that these provisions are ruled unconstitutional, insurers will once again be able to charge prohibitively expensive premiums to these individuals – or to simply deny them coverage outright. This move by the DOJ also injects a fresh dose of uncertainty into the individual health insurance market, further contributing to instability that the administration and its allies in Congress have created.

Even as the Trump administration attempts this major blow to the health law’s provisions on individuals with pre-existing conditions, it also continues its “death by a thousand cuts” approach to upending the nation’s health system under the ACA. The Centers for Medicare & Medicaid Services (CMS) has indicated to states that it supports state waivers to impose work requirements on “able-bodied” adult Medicaid beneficiaries (the Obama administration denied several similar state waiver requests).

To date, CMS has approved such waivers for Arkansas, Indiana, Kentucky, and New Hampshire, with seven other states waiting for approval. Such requirements require beneficiaries to certify that they have completed a certain number of hours of work or “community engagement” in order to be eligible for Medicaid; if they do not do so, they would lose their Medicaid benefits. Such waivers could potentially act as a barrier to coverage, especially considering that most Medicaid beneficiaries already are employed, while those who are not employed generally face significant barriers to employment.

These moves come even as more states realize the positive impacts of Medicaid expansion and as support for the ACA remains high. On Thursday June 7th – the same day, ironically, that DOJ filed its brief – Virginia Governor Ralph Northam signed into law a bill to implement Medicaid expansion, becoming the thirty-third state (plus the District of Columbia) to do so. This expansion, which will not be implemented until January 1st, 2019, provides Medicaid coverage to an estimated 400,000 additional low-income Virginians. Maine voters also voted overwhelmingly last year in favor of Medicaid expansion in the first ballot initiative to do so; Idaho, Nebraska, and Utah are also considering expansion through similar ballot initiatives.

ANA strongly opposes any attempt to weaken protections for Americans with pre-existing conditions to purchase health insurance coverage in order to receive critical healthcare services (the official ANA statement on this move can be found here), as well as any other attempts to erode the healthcare coverage for any segment of the population. These recent moves unequivocally demonstrate how out of step the Trump administration is with the American people when it comes to healthcare. Even as it attempts to take a wrecking ball to the gains made under the ACA, states are taking steps – with significant popular support – to shore up their own healthcare systems.

Healthcare stands to be a major issue in the 2018 midterm elections – 22 percent of respondents to a recent NBC News/Wall Street Journal poll named healthcare as the most important factor in deciding their vote. The administration’s recent moves demonstrate just how much is at stake in these elections. ANA urges you to support candidates who uphold our core values and principles for health system transformation, as well as to engage with ANA’s Year of Advocacy and Hill Day 2018 activities (Hill Day 2018 will be held on Thursday June 21st). It is vital that nurses’ voices as the nation’s most honest and ethical profession and largest group of healthcare providers are heard in the public sphere and that nurses make their influence known.

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Author: Gregory Craig

Analyst in the Health Policy Office of the American Nurses Association.

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