Trump Administration abandoning protections for those with pre-existing conditions

The case is Texas, et al v United States, et al and California, et al - Case Number 4:18-cv-00167-O 

Texas and 19 other states have filed a civil suit in U.S. Federal Court for the Northern District of Texas.  In it, Texas Attorney General Ken Paxton is claiming that by invalidating the Individual Mandate provision of the Affordable Care Act (ACA); it rendered another element of the ACA unconstitutional.  The suit claims the ACA provision that allows insurers to exclude or limit coverage for people with pre-existing conditions is no longer valid.

The ACA was not the first law to address pre-existing condition limitations.  But before delving into the history, let's understand just what insurers did and want to do with people who have pre-existing conditions.

My first dealings with private health insurance came after I left the military.  Because I was employed by the private school, the health insurance company would have to accept me.  But they could limit benefits for any pre-existing conditions I might have had.  For a full year.  If I had purchased a private policy, the insurer could have denied me coverage altogether because of a pre-existing condition.

Then Congress passed the Health Insurance Portability And Accountability (HIPAA) Act in 1996.  One of the provisions of that law was that if you had previously had health insurance coverage and you applied for new coverage without a break of coverage, or with a break in coverage of less than 63 days, the new carrier could not limit your coverage for pre-existing conditions.

Normally it would fall to the Department of Justice (DOJ) to defend the United States from this lawsuit.  The Trump Administration filed a brief with the court that makes it clear they will not.  In their 27 page brief filed by the DOJ, they point out that immediate relief is not required, as the Individual Mandate's repeal is not effective until 1/1/2019.

Interestingly, the same people who were highly critical of the Obama Administration's refusal to defend the Defense of Marriage Act (DOMA) in court have no problem with the Trump Administration's decision to refuse to defend the ACA.  I doubt any of them have a good explanation why it wasn't okay back then but it is okay now.

* * *

There is actually a point to this, but not the point that these 20 conservative states are trying to make.  Requiring insurers to accept anyone regardless of any pre-existing conditions actually allows people to choose to not purchase coverage.  They can wait until they are sick or injured.  For many, it is cheaper to pay the current penalties under the Individual Mandate than to purchase coverage.

The only way health insurance works is to make the pool of covered individuals as large as possible.  Premiums paid by the healthiest people do indeed subsidize the cost of covering those are older and/or sicker.  In turn, as that healthy population ages and becomes ill, the cost of covering them is subsidized in turn by a new pool of health people paying premiums.

There is a reason that states mandate that everyone purchase automobile insurance if they are going to drive a car on public highways.  Accidents happen.  You can't wait until you crash to go buy that coverage.  I believe that the same principle should apply to health insurance.

I have no problem with a law that allows insurers to exclude/limit coverage for pre-existing conditions, IF and only if, the people had the opportunity to purchase coverage and CHOSE not to do so.

We call the ACA "Obamacare" and it may well be the greatest achievement of the Obama presidency.  It isn't perfect.  But it remains a superior solution to any other program enacted before its existence, or proposed since.