Washington, D.C. (Oct. 24, 2018)—Today, Rep. Elijah E. Cummings, the Ranking Member of the House Committee on Oversight and Government Reform, issued a new national-level report and state-level reports on the potential effects of the Trump Administration’s decision not to defend statutory protections for Americans with pre-existing conditions who buy their own insurance.

Before the Patient Protection and Affordable Care Act (ACA) was enacted in 2010, one of the most devastating experiences for Americans with pre-existing health conditions was the refusal by insurance companies to cover them, or to charge them rates that were exorbitantly higher than for people without pre-existing conditions.  This discrimination by insurance companies was allowed under federal law, and it was a leading cause of bankruptcies as families often lost their homes and their entire savings.

Congress ended this legalized discrimination by establishing a set of new statutory protections for people with pre-existing conditions.  Among these protections, insurance companies are now required to offer coverage to everyone, regardless of health status—a protection known as “guaranteed issue.”  Insurance companies are also barred from charging higher premiums on the basis of health status—a protection known as “community rating.”  In addition, insurance companies are now prohibited from selling policies that do not cover pre-existing health conditions—a protection known as the “coverage exclusion prohibition.”  

On June 7, 2018, Attorney General Jeff Sessions sent a letter informing House Speaker Paul Ryan that the Department of Justice no longer will defend in federal court the ACA’s requirement that individuals maintain insurance coverage and that the guaranteed issue, community rating, and coverage exclusion provisions should no longer remain in effect.  He explained that he was acting “with the approval of the President of the United States.” 

The Trump Administration has yet to offer any alternative proposals for individuals with pre-existing conditions who may lose federal protections as a result of the Administration’s actions.

The national report estimates that as many as 15.6 million people in the individual market may lose federal protections against discrimination as a result of their pre-existing health conditions, gender, or age.

• Individuals with Pre-Existing Health Conditions:  As many as 10 million people in the individual market have pre-existing health conditions and may lose federal protections against discrimination.  Of these individuals, 4.8 million with severe pre-existing health conditions may be denied coverage altogether.

• Women:  As many as 9.4 million women in the individual market may lose federal protections against discrimination.

• Older Adults:  Older Americans could be charged more than ten times the amount younger adults pay for their insurance premiums. As many as 6.6 million people between 50 and 64 years old in the individual market may lose federal protections against discrimination.

Although this staff report focuses primarily on those who purchase insurance through the individual market, 151.2 million people across the country with employer-sponsored insurance may also be at risk of losing federal protections.

According to a recent Kaiser Family Foundation poll, nearly three-quarters of the American people believe it is “very important” to retain these protections in the law.

National Report

State Reports

###