Patients fear losing health insurance if Trump-backed lawsuit to gut ACA prevails |

Patients fear losing health insurance if Trump-backed lawsuit to gut ACA prevails

Natasha Lindstrom
AP Photo | Manuel Balce Ceneta
In this March 28, 2019, photo, President Donald Trump speaks at a campaign rally in Grand Rapids, Mich. Trump’s surprise decision to stop defending the Affordable Care Act in court has opened a new debate among Republicans about how to approach health care heading into the 2020 elections, with some fearing the issue remains a vulnerability for the party.

Janice Nathan’s chronic medical condition dates to nearly a decade before the Affordable Care Act protected her from being denied insurance coverage because of it.

Nathan, 62, a speech-language pathologist from Pittsburgh’s Squirrel Hill neighborhood, received a kidney transplant in 2001 while on an employer-sponsored health insurance plan.

Three years later, when Nathan left the company to start a private practice, she had to switch to a much costlier plan “with very limited coverage,” Nathan recalled by phone Tuesday morning. Even worse, “I was always terrified that if my premium was half a second late, I would then have no insurance coverage.”

She signed up for a plan available to the self-employed on the federal health exchange — with better benefits at lower out-of-pocket costs — as soon as it became available following the 2010 passage of the ACA law under the Obama administration.

“The morning I woke up when the Affordable Care Act was enacted, I started sobbing, because from that second on I never had to worry about losing health insurance because of my pre-existing condition,” Nathan said.

“Now, I’ve gone back to being terrified again.”

Obamacare’s fate in question

More than 130 million Americans with pre-existing medical conditions — including more than 5.3 million in Pennsylvania — are among those who could risk losing coverage if a lower court ruling that thrust into question the constitutionality of the Affordable Care Act ultimately prevails.

Oral arguments began Tuesday in a New Orleans federal appeals court to decide whether Congress effectively invalidated former President Barack Obama’s entire signature health care law when it zeroed out the tax imposed on those who chose not to buy insurance. The Texas v. United States case stems from the Republican’s 2017 tax cut bill.

With no tax penalty now in effect, the Texas lawsuit argues, the individual mandate is unconstitutional and the entire law must fall without it. Texas-based U.S. District Judge Reed O’Connor agreed in a December ruling. The law’s supporters appealed.

U.S. Sen. Bob Casey joined Democrats at state and federal levels this week in calling on Republican lawmakers to take a stance on the lawsuit and its potential ramifications. He criticized the Trump administration for refusing to defend the health care law.

“There’s no backup plan, there’s no Republican replacement plan,” Casey, D-Scranton, told reporters on a conference call Tuesday morning. “This is totally irresponsible. … They don’t seem to give a damn if this coverage is ripped away.”

Casey accused President Trump and the GOP of trying to “sabotage” the Affordable Care Act since taking office, citing failed attempts to repeal the law via legislation, ongoing efforts “to decimate Medicaid and end Medicaid expansion” and proposed budgets that slash appropriations for Medicaid and Medicare.

“This is an effort by a corporate White House led by corporate Republicans in the House and Senate to do in the courts what they couldn’t do in the halls of Congress when we stopped them in 2017,” Casey said. “We have to do everything we can to sound the alarm about the devastating impact of this lawsuit, we have to continue to hold Republican members of Congress accountable.”

Lehigh Valley Republican Sen. Pat Toomey balked at the notion that the GOP is against helping people with pre-existing conditions retain insurance coverage. He declined to comment specifically on the lawsuit while it’s playing out, citing policy not to comment on active litigation.

But he wanted to make clear one point: “There is not a single Republican senator who believes people with chronic and/or expensive pre-existing conditions shouldn’t have access to quality, affordable health care,” Toomey said.

Toomey said he would support a speedy resolution to the pre-existing conditions issue should the need arise.

‘Too much is at stake’

The lawsuit threatens not only to end protections for pre-existing conditions but “could create a striking blow to the entirety of the Affordable Care Act,” said Antoinette Kraus, executive director of the Pennsylvania Health Access Network, a patient advocacy organization. She dismissed as a “misguided decision” O’Connor’s ruling that, by taking the tax away, Republicans “sawed off the last leg (the ACA) stood on.”

“We hope that the ruling will be overturned based on weak legal grounding and grave harm overturning the ACA would cause Pennsylvanians and millions of Americans,” Kraus said. “Too much is at stake.”

The ultimate outcome will affect protections for people with pre-existing conditions, Medicaid expansions covering roughly 12 million people, and subsidies that help about 10 million others afford health insurance.

“I heard them (Republicans) last year when I was running for re-election in Pennsylvania. Over and over again, they said, ‘Oh no, well we’re for guaranteeing protections for pre-existing conditions’ — well, that’s a big lie, if you support the lawsuit,” Casey said.

An estimated 858,000 Pennsylvanians enrolled in federal health exchange plans could lose coverage, and so could another 89,000 young adults allowed to stay on their parents’ health plans until age 26 under the ACA, data from the Urban Institute suggests.

Employers could return to placing annual and lifetime limits on employees’ health care or not providing it at all, and preventative care no longer would be assured by federal subsidies. Another 800,000 Pennsylvanians enrolled in Medicaid expansion also could lose coverage.

Support for rural hospitals, in particular, would be in jeopardy amid potential federal cuts to health care topping $5 billion, Casey said.

“Rural hospitals will close, rural Pennsylvanians will have much less access to care, and we’ll lose a lot of jobs in the process,” Casey said. “So, the Texas lawsuit is not only bad for health care and for the 642,700 Pennsylvania children, it’s also bad for employment in a state like ours.”

Casey acknowledged that Democrats can be doing more to address health care, too. He said he remains open to bipartisan talks about efforts to reduce costs of health care and especially the costs of prescription drugs.

“Democrats in Congress, I’ll say it bluntly, are not doing enough …” Casey said. “We’ve got to ramp up and amp up our game to stop Republicans from destroying our health care system, ripping away coverage from more than 20 million people and ending protections for more than 150 million Americans.

“Very few Americans know what’s happening,” Casey said. “Most people in this state don’t even know this lawsuit is underway, quite frankly.”

Tuesday’s arguments are the latest in a lawsuit filed by Republican officials in 18 states, led by the Texas Attorney General’s Office.

In addition to the 18 states, two individual taxpayers are part of the lawsuit. The Trump administration is not defending the law and has filed arguments in favor of O’Connor’s ruling.

It was unclear when the three-judge panel of the 5th U.S. Circuit Court of Appeals panel would rule in the case, which could be destined for the U.S. Supreme Court. The high court has previously reviewed the law, and its coverage and insurance protections for millions of Americans.

Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, [email protected] or via Twitter .

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