Note: This piece was originally published in October 2018.
As many as 146,000 people in Alabama who have pre-existing conditions and purchase their health insurance coverage through the individual market could see premium increases or lose their coverage if the Affordable Care Act is overturned in court, according to a new report from the House Oversight Committee’s Democratic staff.
Earlier this year, Attorney General Jeff Sessions wrote to House leadership notifying them his attorneys in the Department of Justice would no longer defend the Affordable Care Act’s individual mandate from challenges in court. As a result, the plaintiffs in the case making its way through federal courts now say the law’s provisions that protect individuals with pre-existing conditions from discrimination in the health insurance marketplace would also be invalidated without the ACA’s core provision.
Sessions even noted that his decision to no longer defend the law is a break from the tradition of DOJ attorneys defending federal laws.
“As you know, the Executive Branch has a longstanding tradition of defending the constitutionality of duly enacted statutes if reasonable arguments can be made in their defense,” Sessions said, noting he thought there were special considerations when it comes to the Affordable Care Act.
At the same time, Alabama Attorney General Steve Marshall recently signed on to the multi-state lawsuit seeking to overturn the Affordable Care Act, more commonly referred to as Obamacare. The case, Texas, et al. vs. the United States, et al., is currently being heard in the United States District Court for The Northern District of Texas, where 17 other Republican attorneys general and two Republican governors are suing to overturn the Affordable Care Act.
“The Trump Administration’s decision not to defend key federal protections against insurance company discrimination threatens more than 130 million people with pre-existing health conditions in the United States, including 146,000 people who obtain coverage through the individual market in the State of Alabama,” the report reads.
Of the 146,000 people in Alabama with pre-existing conditions enrolled in an individual market plan, 88,000 of them have conditions severe enough that insurers could deny them coverage altogether, should the protection provisions of the ACA be overturned.
People who purchase their coverage on an individual basis are most at risk because they lack group buying power available to those who have insurance through their employers.
But, in total, more than 900,000 people in Alabama have a pre-existing condition. While the legal peril facing the law poses a greater threat for those who buy their insurance coverage on an individual basis, thousands of others who have health insurance through their employers could also be threatened.
“As a result of the Trump Administration’s decision not to defend this provision, employer plans once again will be able to exclude coverage for preexisting health conditions to new employees for up to a year if they did not maintain continuous insurance coverage before enrolling in the employer’s insurance plan,” the report found.
The Democratic staff report is based on data from the 2016 American Community Survey, which is compiled by the Census Bureau.
Without the individual mandate, insurers who provide individual plans in the health insurance marketplace have warned that premium price hikes could come in 2019. States have already reported increases, largely because payers fear healthy individuals will flee the ACA market, leaving higher-cost, more at-risk insurees.
Women and older adults would also lose protections if the law were overturned. As many as 140,000 women who currently purchase health insurance on an individual basis could face denials or premium increases, the Democratic report found. Thirty-one thousand women who are in households above the limit to qualify for federal financial assistance could bear the full cost of those increases.
For Alabamians between the ages of 50 and 64, 91,000 purchase health insurance through the individual market and could lose protections from the Affordable Care Act if it were to be overturned.
Nationally, as many as 10,030,000 people across the country who purchase insurance through the individual market have pre-existing health conditions and may lose federal protections against coverage denials or premium increases as a result of the administration’s decision not to defend the law.
Of that number, 4,823,000 have pre-existing health conditions severe enough that insurers may deny them coverage altogether.