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Updates from Washington

UPDATE: Pre-existing Condition Protections Under Threat

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Editor's note: This is an update to a blog that was originally published on July 13, 2018.

On December 14, 2018, a federal judge in the state of Texas ruled that the Affordable Care Act (ACA) is unconstitutional. This is not the final ruling in the case, and it will be appealed. The ACA remains in effect at this time. The Department of Health and Human Services will continue to administer and enforce the ACA, and the ruling has no immediate impact on individuals receiving coverage through the health care exchanges.

A range of health care provider groups are speaking out against the Attorney General's recent announcement concerning coverage for pre-existing conditions under the Affordable Care Act (ACA).

A joint statement from the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association and American Psychiatric Association reads in part: "As physicians who provide a majority of care to individuals for physical and mental conditions, we can speak clearly that these insurance reforms and protections are essential to ensuring that the more than 130 million Americans, especially the more than 31 million individuals between the ages of 55 and 64, who have at least one pre-existing condition are able to secure affordable health care coverage."

On June 7, the Department of Justice announced that it will not defend a key ACA provision that protects people with pre-existing conditions from being denied coverage or charged more by insurance companies.

People with Parkinson's are by definition living with a pre-existing condition. In some cases, such individuals could lose access to their insurance altogether.

This unusual DOJ action comes in response to a lawsuit brought by 20 states, led by the Attorney General of Texas, challenging the constitutionality of the ACA. (The lawsuit specifically focuses on the individual mandate, which is necessary to ensure that health care costs are shared across a wide range of individuals, including those with greater and lesser needs, creating average affordable premiums for most.)

In 2012, the Supreme Court ruled that the ACA was a constitutionally valid exercise of the government's power to tax. But the Justice Department now claims that this justification is no longer valid, due to changes to the tax code passed by Congress in 2017.

If the court accepts this argument, "insurers will be allowed to go back to pricing plans based on health conditions, a change that would in many ways turn back the clock to how individual coverage was sold before the ACA," reports The Wall Street Journal.

A court decision could be several months away. Until that point, the provision will likely stay in effect. Stay tuned to the Foundation blog for updates and any relevant action steps.

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