APA Calls on Administration to Defend Patient Protections in ACA

APA strongly condemned the decision last month by the Trump administration to not defend the patient protections provided in the Affordable Care Act (ACA) in the case Texas v. United States.

The unusual decision of the Department of Justice (DOJ) to not defend a U.S. law opens the door to allow insurers in the individual market to deny coverage or raise the premiums for Americans with preexisting conditions or a history of using more health care. Although the precise number is hard to pin down, at least 18 million individuals buy insurance outside of the group market and would be affected by such a change, according to a data analysis by the Kaiser Family Foundation. Moreover, about 130 million Americans have at least one preexisting health condition and could potentially lose coverage or face rate increases.

“We strongly condemn the administration’s decision not to defend the patient protections provided in the Affordable Care Act, an established law of the land,” APA President Altha Stewart, M.D., said in a statement. “This is harmful to the health of Americans and is very short-sighted, considering the nation is in the midst of an opioid epidemic and a 30 percent rise in suicide rates. We call upon the administration to reverse this decision and defend the rights of our patients.”

The Department of Justice filed a memorandum June 7, advising a U.S. District Court that it would not defend the ACA’s individual mandate to maintain health coverage. Rather, the DOJ found the mandate to be “unconstitutional” as of January 1, 2019. That’s when the Tax Cuts Jobs Act eliminates the ACA’s penalty for individuals who do not carry insurance.

In a prior court battle, the Supreme Court had upheld the ACA’s individual mandate, which requires most people to carry minimum essential health insurance, but only in so far as it was a tax provision that yielded at least some revenue for the federal government. But because the Tax Cut Jobs Act eliminates the ACA’s penalty for not carrying insurance starting January 1, it will no longer generate revenue. Thus, the DOJ determined that the individual mandate will no longer be constitutional as of that date. Texas, along with 19 other states, had filed a federal lawsuit in February challenging the individual mandate and other patient protections in the law.

At the same time, the DOJ also advised the court to strike down two of the ACA’s key patient protections intended to help individuals purchasing non-group health insurance: “guaranteed issue,” which requires insurers to provide coverage to those with preexisting conditions, and “community rating,” which requires insurers to charge the same premiums regardless of medical history.

“The Executive Branch has a longstanding tradition of defending the constitutionality of duly enacted statutes if reasonable arguments can be made in their defense,” Attorney General Jeff Sessions noted in a letter to Congress June 7. Nevertheless, “I have concluded that this is a rare case where the proper course is to forgo defense” of the mandate for individuals to buy insurance, he wrote. Sessions wrote that the decision had been made with the approval of President Trump.

APA also teamed up with five other medical organizations representing more than 560,000 physicians and medical students to lobby on the issue. “We strongly urge the Department of Justice to reconsider its decision in Texas v. United States. [We] all seek policy solutions that increase access to affordable health care that provides all individuals, regardless of their gender, race, and health status, reasonable protections against discrimination in coverage and pricing,” they wrote in a June 11 statement.

California Attorney General Xavier Becerra formed a coalition with 17 attorneys general to fight to uphold the ACA and is vowing to explore all legal options to defend it. The group filed a motion to intervene in Texas v. United States and became defendants in the case in mid May. A group of patient advocates, medical associations, public health experts, economists, and legal experts also submitted amicus briefs to the court in support of the group.

Next, the judge in the case will review the filings and determine whether a hearing is needed in this case. The state of Texas must respond to the democratic state attorney general’s filings this month. ■

The DOJ’s brief can be accessed here. APA’s statements are available here.