Published: Mon, June 11, 2018
Medical | By Vicki Mclaughlin

Trump Seeks End to Pre-existing Condition Mandate

Trump Seeks End to Pre-existing Condition Mandate

The Trump administration said in a court filing late Thursday that it will no longer defend key parts of the Affordable Care Act, including the requirement that people have health insurance and provisions that guarantee access to health insurance regardless of any medical conditions.

Unless you have been vacationing in a far away galaxy, you will have heard the ululations of Obamacare apologists enraged by the Trump administration's refusal to defend the health care law against a 20-state lawsuit challenging its constitutionality.Obamacare advocates claim that the failure to defend the ACA in Texas v. "Instead, it exacerbates our current challenges and creates further uncertainty that could ultimately result in higher costs for millions of Americans and undermine essential protections for people with pre-existing conditions, such as asthma, heart disease, arthritis and diabetes", Collins said.

If the judge agrees, "insurers would want to discontinue" health plans that treat healthy and sick customers the same, predicted Larry Levitt, a senior vice president at the Kaiser Family Foundation.

Republicans in Congress have tried endlessly to the repeal the Affordable Care Act since it was signed into law in 2010 by President Barack Obama.

The president past year issued an executive order directing federal agencies to make it easier to buy two alternatives to Affordable Care Act plans. And because a scant majority of the Supreme Court had said it was Congress's taxing powers that saved the ACA from being unconstitutional, that protection was no longer there. In the meantime, the existing law will likely remain.

Nicholas Bagley, a professor at the University of Michigan Law School who had been a Justice Department lawyer, says DOJ's move is troubling. They included provisions establishing health insurance exchanges, expanding Medicaid coverage and subsidizing premiums for lower-income people. It argues that because the tax reform bill passed by Congress gets rid of the ACA's "individual mandate" penalty for not having health insurance, the requirement for individuals to have health insurance is void, and because of that, the rest of the law - which they say hinges on the mandate - should be invalidated. Without that form of tax, the new Administration document noted, the ACA mandate to buy insurance would be unconstitutional as beyond Congress's power to regulate interstate commercial activity.

Sixteen states have intervened in the case to support the law.

Some Democratic politicians didn't waste much time.

Crusading against the ACA has been a priority of President Donald Trump since his campaign for the White House.

As many as 130 million adults under age 65 in the US have pre-existing conditions that could result in their not being able to get insurance coverage in the private market, according to the Department of Health and Human Services.

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This is a huge deal... the administration's behavior sets a risky precedent about the obligation of this and future presidents to follow their constitutional duty to faithfully execute the laws enacted by Congress.... The individual mandate required most Americans to maintain minimum insurance or to pay a tax penalty. Under another provision, the community rating provision, insurers were not allowed to set premiums based on a person's health history.

The Department of Justice has said it will not legally defend the ACA's restriction on insurers asking about pre-existing health conditions as a determinant for whether to offer coverage and at what rates, saying it believes the provision is unconstitutional.

"The goal of Texas' lawsuit is to leave Americans without health insurance, forcing them to choose between their health and other needs", says California Attorney General Xavier Becerra. Chris Murphy, D-Conn., said in a statement.

The same report estimates 391,000 Utahns have pre-existing conditions that could affect their coverage eligibility.

Just hours before the Justice Department officially withdrew from the case, three of the staff attorneys who had been working on it withdrew.

The Justice Department took a different tack in a court filing on Thursday.

And Tim Hogan, a spokesman for Health Care Voters, a Democratic group looking to mobilize voters on the health care issue, called the decision a "blatant sabotage of the Affordable Care Act" and "something Republican members of Congress will have to explain to their constituents". Whatever the lower courts decide, the case seems destined to reach the Supreme Court.

The Texas case will be decided first by O'Connor, a conservative appointee of President George W. Bush.

The states' challenge to the overall ACA has been pending since February in the Fort Worth court of U.S. District Judge Reed C. O'Connor.

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