52 million Americans could be affected by the latest healthcare tripwire purposefully set off by the Trump administration, which is declining to support certain mandates that include protections for pre-existing conditions.
In 2016, a Kaiser Family Foundation study estimated that 27 percent of adult Americans under the age of 65 had health conditions that would likely leave them uninsurable if they applied for individual market coverage without protection. It’s unclear how many would be unable to get insurance currently because, while the individual market has grown, many also receive employment-based insurance or are on Medicaid, or in some instances, Medicare.
Trump’s Justice Department will no longer defend certain Affordable Care Act provisions, including requiring people carry health insurance and guaranteeing access for people with medical problems and limit what insurers can charge older, sicker adults. Ironically, southern states that voted for Trump have a higher rate of these adults, including Tennessee (32%), Arkansas (32%), Alabama (33%), Kentucky (33%), Mississippi (34%), and West Virginia (36%), where at least a third of the non-elderly population would have declinable conditions, according to a Kaiser report.
Twenty Republican state attorneys general had filed a lawsuit that Congress’ changes to the law in last year’s tax bill rendered the entire ACA unconstitutional. In the tax law, Congress repealed the penalty for people who failed to have health insurance starting in 2019.
California Attorney General Xavier Becerra, who has defended the ACA, told Kaiser Health News that attacks by the Trump administration threaten health care for millions of Americans. He accused the administration of going “AWOL.”
“It’s, simply put, an attack on the health care that millions of Americans have come to count on, and California, being the most successful state in implementing the Affordable Care Act, stands to lose perhaps more than anyone else,” he told KHN.
About 1.5 million Californians buy coverage through the state’s ACA exchange, Covered California, and nearly 4 million have joined Medicaid as a result of the program’s expansion under the law.
The trade association, America’s Health Insurance Plans, which represents insurers, was obviously unhappy with the recent developments: “Zeroing out the individual mandate penalty should not result in striking important consumer protections, such as guaranteed issue and community rating rules that help those with pre-existing conditions. 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.”
Propping up the health insurance industry and protecting policyholders has already been a dysfunctional balancing act that has resulted in increasing premium hikes for financially struggling families. The latest attack on the ACA, which Republicans already roiled last year with cuts, will either increase the double digit premium increases that have occurred over the past few years, along with growing co-pays and deductibles, even more or force insurance companies to drop out of the ACA marketplace all together.
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