Legal battle threatens coverage for millions of Americans with pre-existing conditions

By American Heart Association News

Courthouse building

A legal challenge seeking to remove insurance coverage protections for pre-existing conditions would have a devastating impact on millions of people in need of care, the American Heart Association and other patient advocates say in a new court filing.

The American Heart Association, American Cancer Society Action Network, American Diabetes Association, American Lung Association and National Multiple Sclerosis Society filed a “friend-of-the court brief” Thursday in U.S. District Court in the case of Texas v. United States of America.

Led by Texas Attorney General Ken Paxton, 20 states filed the lawsuit in Texas federal court earlier this year. They argued that the ACA was invalid because of the congressional repeal of the individual mandate tax legislation.

The patient groups’ filing came in response to the Trump administration’s decision not to defend several critical patient protections provided by the Affordable Care Act, including coverage of pre-existing conditions.

“The critical patient protections in the health care law provide an essential lifeline for millions of Americans who suffer serious illnesses, like cancer, lung and heart disease, diabetes, neurological and chronic respiratory conditions,” the patient groups said in a statement. “Their ability to access affordable, meaningful health insurance is critical to their health and wellbeing.”

Last week, the Department of Justice announced it would be siding with the plaintiffs and would not defend the ACA. In a court filing, the administration urged the court to strike down the two key provisions of the ACA: a requirement that insurers provide coverage for people with pre-existing conditions, and one that prevents insurers from charging people higher premiums because of pre-existing conditions.

If the court agrees, insurers could once again charge more or deny coverage based on medical history.

Officials with the American Heart Association, which advocated for passage of the ACA, note that 21 million Americans could lose their health insurance coverage by 2020 if the ACA is overturned.

Among them would be survivors or people at high risk for heart disease and stroke – the two leading causes of death in the world. Pre-existing conditions would include high blood pressure, congenital heart defects and stroke.

A 2017 study published in the journal Circulation found that in the first year after implementation, 7 million people at risk of or with cardiovascular diseases gained insurance coverage.

The ACA provides coverage for people regardless of their employment and pre-existing conditions, allowing more people access to doctor’s visits, prescription medication and other lifesaving treatments.

One study of emergency medical services in Portland, Oregon, found that out of hospital cardiac arrest fell 17 percent among middle-age adults who gained coverage through the ACA, primarily through Medicaid expansion.

This uncertainty of the ACA’s future has begun to shake the confidence of insurers. Some insurers already are hiking their premiums for ACA insurance rates by 30 percent or more, according to the Kaiser Family Foundation.

Andrew Blackshear with his sister, Jacquelyn Carpiaux (Photo courtesy of Andrew Blackshear)
  After an infection led to emergency heart surgery and heart failure,
  ACA health insurance covered Andrew Blackshear's second surgery.
  Blackshear with his sister, Jacquelyn Carpiaux. (Photo courtesy of
  Andrew Blackshear)

While the case slowly makes its way through the courts, heart disease survivors such as college student Andrew Blackshear, of Benicia, California, are left to wait in limbo.

In 2016, Blackshear, 29, was diagnosed with “valley fever,” an infectious disease caused by fungal spores found in California’s dry soil and dirt. After experiencing a high fever for three weeks, he learned the disease had reached his heart.

Within weeks of his first surgery, he went into heart failure.

He then endured arduous recovery, as well as a battle with his insurance company, which refused to pay over $100,000 he owed the hospital.

The company claimed he had not disclosed a pre-existing condition and would drop his insurance coverage, he said. Blackshear then spent months searching for paperwork to prove that he did not have a pre-existing condition.

“While I’m battling for my life, I’m on a scavenger hunt for paperwork,” he said.

Eventually, Blackshear accessed more comprehensive coverage through the ACA, and his plan covered his second surgery.

He’s spent the past few years recovering and getting his life back in order.

Now, though, because of the latest threat to the ACA, patients like Blackshear are worried all over again about whether their medical history could cause them future troubles.

“We can’t go backward and deny coverage for people with pre-existing conditions, especially those suffering from serious health problems like cardiovascular diseases that require ongoing medical care,” said American Heart Association CEO Nancy Brown.

“People everywhere deserve access to affordable and quality care to prevent and treat heart disease and to achieve better health outcomes.”

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