What If the Pre-existing Condition Mandate Is Repealed?

I am one of the more than 133 million adults under age 65—just over half (51 percent) of the non-elderly population—in the U.S. that has a pre-existing condition and am now at risk of losing health insurance. I was born with arthrogryposis, a disability that limits the use of my arms and legs. Last week, the Trump administration decided that the U.S. Department of Justice will no longer defend the Affordable Care Act, including its mandate to insure people with pre-existing conditions, in court challenges. If insurers are not legally required to cover people like me, they most likely won’t. I have lived through this and am deeply concerned about what will happen if the pre-existing condition mandate is repealed.

In 2010, President Barack Obama signed the ACA into law. Among the law’s broad-sweeping provisions was its mandate that health insurance companies offer its services to people with pre-existing conditions, which became effective in 2014. Before the ACA, health insurers were legally allowed to deny people with pre-existing conditions, like me, coverage or require us to pay extra.

Pre-existing conditions are considered to be any health issue one has before their new health insurance coverage begins. Examples include epilepsy, obesity, heart disease, paralysis, cancer, sleep apnea, lupus, diabetes, genetic conditions, and pregnancy. Mental health conditions, such as depression, anxiety, and bipolar disorder, are also considered pre-existing conditions.

Likely because so many Americans have a pre-existing condition, or know someone who does, the pre-existing condition mandate of the ACA continues to be quite popular. A Kaiser Family Foundation tracking poll in June 2017 found that 70 percent of adults want Congress to preserve pre-existing condition protections. Further, polling suggests that health care is an important issue for voters this year. Indeed, an NBC News/Wall Street Journal poll released last week found that 22 percent of respondents said health care would be the most significant factor in deciding their vote, ahead of the economy, guns, taxes, and immigration.

Nonetheless, the ACA has been under incessant assault by the GOP, especially since Trump took office. Throughout 2017, GOP senators and representatives made several unsuccessful attempts to repeal the ACA. Indeed, disability activists—who spent the spring and summer of 2017 protesting repeated attempts to undermine the ACA—are undoubtedly the reason the law hasn’t been repealed thus far.

Although the GOP was not able to outright get rid of the ACA, Republicans are certainly chipping away it. The tax bill, for instance, which passed in 2017, repealed the individual mandate provision in the ACA. Without such a mandate, people who are healthy will be less likely to enroll in health insurance coverage and balance out the costs of those who have pre-existing conditions.

Conservative states have also tried to use the courts to repeal the ACA, mostly unsuccessfully to date. However, last week, the DOJ announced that it would not defend the ACA in a lawsuit brought by 20 states. In that case, the states, led by Texas Attorney General Ken Paxton, argue that the ACA is unconstitutional. If the ACA is determined to be unconstitutional, the protections for people with pre-existing conditions will be gone. In other words, health insurance companies will once again be legally allowed to deny people like me coverage or require us to pay extra.

Of course, the Trump administration’s desire to repeal the ACA is just another attack on people with disabilities by the administration and the GOP writ large. As I wrote for Rewire.News, Trump’s first year in office “threatened nearly every facet of life for people with disabilities.” For example, Congress is currently considering legislation that would significantly weaken the 28-year-old Americans with Disabilities Act (ADA).

As the GOP continues its efforts to undermine disability rights, Republicans  appear to forget that we vote. The 2018 midterms are expected to be incredibly consequential, with Democrats vying to take both the House and the Senate. Historically, disability has been a bipartisan issue. Indeed, most federal laws protecting the rights of people with disabilities were signed into law by Republican presidents. However, things have changed and that could mean trouble for the GOP in the upcoming election.

In 2016, 62.7 million eligible voters either had a disability or had a household member with one, according to researchers from Rutgers University, and that number is certainly bigger when you include voters who have a pre-existing condition. That means that the GOP should remember that more than 25 percent of the total electorate have a personal connection to disability.

Two things are crystal clear: First, the GOP is continuing to threaten the lives of people with disabilities, this time via the administration’s recent decision to not defend the ACA, a law that has greatly improved our lives. And, second, the power of the disability vote is significant and we will not forget these continued attacks when we head to the polls in 2018!