HARTFORD, CT — If the ruling striking down all of the Affordable Care Act by a Texas judge is upheld, some Connecticut residents will be protected from the elimination of the popular clause requiring health insurers to cover pre-existing conditions.
Insurance Commissioner Katherine Wade said Monday that any plan in the individual or small group market that’s longer than six months includes protections for residents with pre-existing conditions.
Connecticut’s health insurance law — Chapter 7, Section 38a-476, Pre-existing condition coverage — already states that “no individual health insurance plan or insurance arrangement shall impose a pre-existing conditions provision on any individual.”
However, any short-term insurance plan of less than six months can impose a pre-existing conditions provision, but it can’t eliminate the mandate on essential benefits, according to an Aug. 9, 2018 memo from Wade.
The Connecticut law protecting pre-existing conditions was on the books before the Affordable Care Act was signed into law in 2010.
But Connecticut’s laws only impact about 35 percent of fully insured plans in the state. The other 65 percent are governed by the federal government under the Employee Retirement Income Security Act of 1974.
In Connecticut there are 2.21 million privately insured residents. Of those, about 1.85 million get their insurance from large group plans, 131,000 have individual plans, and 235,000 people are covered under small group plans. The Insurance Department doesn’t regulate the plans of 1.85 million people in the large group market, where the terms of employee benefits are set by employers. An employer hypothetically could opt not to cover pre-existing conditions if the repeal of the ACA is upheld.
So of those 2.21 million privately insured residents, the 366,000 with individual plans or who are covered under small group plans are protected from losing coverage for pre-existing conditions if the ACA repeal is upheld. And for those who get their insurance through their employer in large group plans, it would be up to their employer whether they want to continue offering coverage for pre-existing conditions, or even any insurance plans at all. Without the ACA, employers aren’t required to offer any health care benefits.
However, in anticipation of the possible repeal of the ACA, Connecticut lawmakers passed HB 5210 earlier this year to provide some extra protections.
HB 5210 protects the ACA’s essential health benefits, such as prescription drug coverage, maternity care, pediatric services, and preventative care, for anyone who has a plan regulated by the state Insurance Department. It also requires some plans to provide preventative services for women, children and adolescents at no cost.
State Rep. Sean Scanlon, who chairs the Insurance and Real Estate Committee, said Republicans were so intent on repealing this law they failed to realize that “millions of Americans are benefiting from this whether you buy your insurance on the exchange or not.”
U.S. Sen. Chris Murphy described the Texas ruling as a “five-alarm fire.”
“The anti-health care zealots in the Republican Party are intentionally ripping health care away from the working poor, increasing costs on seniors, and making insurance harder to afford for people with pre-existing conditions,” Murphy said. “Don’t be fooled, this rests one hundred percent on the shoulders of President Trump and Republicans in Congress who empower him. Trump took the extraordinary step of sending his lawyers to argue to end health coverage for 20 million people and he got his wish. Not a single Senate Republican challenged him, and now they own this disaster as much as he does.”
In Connecticut, the issue of health insurance coverage is a little more bipartisan.
“Through bipartisan efforts we have protected core elements of the ACA in Connecticut and we must continue to do so,” Sen. Kevin Kelly, co-chair of the Insurance and Real Estate Committee, and Sen. Republican leader Len Fasano, said. “Unlike Washington, here in Connecticut health care policy has been a bipartisan endeavor with Republicans and Democrats working together to protect core elements of the ACA that have benefited residents. Now more than ever we do not need the partisan blame game we see in Washington. We need to continue working with one another to make health care affordable and accessible.”
This year’s midterm election results seemed to demonstrate that American voters want quality, affordable health care that protects individuals with pre-existing conditions. On the campaign trail this year Republican candidates nationwide said they supported a healthcare system that protects individuals with pre-existing conditions.
“I would suggest to any right wingers celebrating this decision to be careful what you wish for,” Tom Swan, executive director of the CT Citizen Action Group, said. “People do not want to see health care ripped away from millions of Americans so that insurance companies can discriminate against people with pre-existing conditions or so women can be treated as second class citizens. If they thought 2018 was a blue wave, wait until 2020.”
The Texas lawsuit was filed by 19 Republican attorneys general.
Curtis Hill, the Republican Attorney General from Indiana who helped challenge the ACA, said the decision was a “victory for all Americans who believe in the principles enshrined in our U.S. Constitution.”
In a statement, he said Congress should continue to play a strong role in promoting access to quality healthcare for all Americans. “At the same time, however, it also must respect the authority of Indiana and all other states to exercise freedom in ways we address the issue of health care for our own citizens.”
While the political battle will continue, so will the legal battle.
“I think there are a lot of people who are viewing this as an end to the ACA and we are very far from that,” Scanlon said Saturday.
He said it will be appealed to the U.S. Supreme Court, which has twice ruled that the law is constitutional.
Quinnipiac University Professor Angela Mattie said Monday that people with health insurance in Connecticut shouldn’t be panicking right now.
“The exchanges are going to move forward,” Mattie, who is in the Dept. of Healthcare Management and Organizational Leadership, said. “The end result of what happened in Texas is a long way away.”
She said everyone should want people to have insurance because when people are uninsured usually the only care available to them is often expensive and inappropriate care in the emergency department for minor conditions or delaying preventive care until a serious condition develops.
“Ultimately, society bears this cost,” Mattie added.
The U.S. Department of Health and Human Services issued a statement Monday explaining that the ruling was not an injunction that halts enforcement of the law and was not a final judgment.
“HHS will continue administering and enforcing all aspects of the ACA as it had before the court issued its decision. This decision does not require that HHS make any changes to any of the ACA programs it administers or its enforcement of any portion of the ACA at this time. As always, the Trump Administration stands ready to work with Congress on policy solutions that will deliver more insurance choices, better healthcare, and lower costs while continuing to protect individuals with pre-existing conditions.”
EDITOR’S NOTE: This story was edited to correct erroneous information provided by sources and to clarify.