If the Supreme Court strikes down the Affordable Care Act, one group is certain to feel the impact acutely: people with pre-existing conditions.
Patients with pre-existing coverage struggled to get coverage prior to the advent of the ACA, as insurance companies tried to avoid taking on patients who would be likely to cost more than they would pay in premiums. The new law requires all Americans to have coverage, and also requires insurance companies to take all comers. It also provides for subsidies for people who cannot afford coverage. During the period leading up to the law’s full implementation, a national insurance pool has been created as a bridge for people with pre-existing conditions.
All of those provisions are imperiled, however, by the case currently before the Supreme Court. While it is unclear whether the court will strike down the entire law, or even part of the law, the part of the law requiring coverage for people with pre-existing conditions is the most at risk.
Those people include patients like Eric Richter, whose story was highlighted in a New York Times article:
The tumor grew like a thick vine up the back of Eric Richter’s leg, reminding him every time he sat down that he was a man without insurance. In April, when it was close to bursting through his skin, he went to the emergency room. Doctors told him it was malignant and urged surgery.
His wife called every major insurance company she found on the Internet, but none would cover him: His cancer was a pre-existing condition. In desperation, the Richters agreed to pay half their hospital bill, knowing they could never afford it on their combined salaries of $36,000 a year.
If the Affordable Care Act had been in place, insurance companies would have been required to cover Richter, and he would have his premiums capped at $285 a month, with tax credits covering anything over that.
While the ACA has not been fully implemented, there is at least one option available for patients with pre-existing conditions. The Pre-Existing Conditions Insurance Plan, or PCIP, offers insurance for those who do not get insurance through work, and who do not qualify for Medicaid. While patients must be without insurance for six months before qualifying for PCIP, it offers an option for coverage for people who would not otherwise be covered. The plan is designed to phase out once the ACA mandates begin in 2014.
But the PCIP was created by the ACA. Like other provisions, its continued existence is in doubt if the entire law is struck down.
If the ACA is struck down in whole or in part, Democrats and President Barack Obama have said they will try to repair the damage. Republican presidential candidate Mitt Romney has said that he would support some limited extension of care for people with pre-existing conditions, but only for people who had previously had insurance.
Democrats have been hopeful that if the Supreme Court acts, it will only strike down the mandate and requirement of coverage for pre-existing care. There are provisions in the law that would certainly benefit a number of Americans — subsidies for coverage, requirements for large companies to cover employees, and provisions allowing young adults to remain on their parents’ insurance through age 26. But for people with pre-existing conditions, those provisions may not mean much; if insurance companies do not need to take people who are already ill, all the subsidies in the world won’t help them.
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