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HARTFORD, CT — Connecticut has done some defense work on health coverage since the Affordable Care Act was passed nine years ago, but if the courts strike down the entire law it would still be “catastrophic” for the state, according to Health Care Advocate Ted Doolittle.

On Monday, the Justice Department told the courts they should strike down the entire ACA— not just its protections for pre-existing conditions.

Doolittle said if the ACA were struck down by the courts it would mean children up to the age of 26 would no longer be able to stay on their parents insurance, 71 percent of individuals participating in the Connecticut exchange would lose their federal subsidies, and Medicaid expansion would disappear.

An estimated 14,000 Connecticut residents under the age of 26 gained coverage through their parents who participate in Connecticut’s insurance exchange also known as Access Health Connecticut. Former Office of Policy and Management Secretary Ben Barnes said in a court affidavit, it’s unclear how many residents participating in other health insurance policies under the age of 26 would lose coverage, but his best guess is tens of thousands more.

In 2019, Access Health Connecticut enrolled 111,066 individuals and 78,654 of those members are subsidized. That means their insurance costs would go from in some cases $0 per month to $351 per month for a single 27 year old on a silver plan, if the court strikes down the entire ACA.

It would also cause 240,000 residents covered through the Medicaid expansion to lose their coverage.

Connecticut, which was the first to take advantage of Medicaid expansion, has received $5.9 billion for this population from 2010 through December 2017.

Repealing the premium subsidies and Medicaid expansion, would according to Barnes’ 2018 affidavit, result in the loss of 35,900 jobs across many industries in Connecticut. Over a five year period it would also result in the loss of $12.5 billion in federal funds, $39.1 billion in business output, $23.3 billion in gross state product, and $748 million in state and local taxes.

Connecticut has done a few things to improve its defenses if the ACA does disappear.

Connecticut lawmakers passed HB 5210 last 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.

Also Connecticut’s health insurance law — Chapter 7, Section 38a-476, already states that “no individual health insurance plan or insurance arrangement shall impose a pre-existing conditions provision on any individual.”

But that pre-existing coverage protection only applies to fully insured plans in the state.

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 court strikes down the ACA.

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.

On Tuesday, Attorney General William Tong joined 21 attorneys general in filing an opening brief in the lawsuit defending the Affordable Care Act.

“Connecticut stands with 21 states across the nation in defending cancer patients, pregnant women, people with diabetes, young people on their parent’s insurance, seniors and others—all who would be severely harmed by this politically-motivated lawsuit,” Tong said.

The brief Tong helped file Tuesday argues that the 18 states led by Texas and two individuals who filed the lawsuit don’t have standing to challenge the minimum coverage provision, because they suffer no legal harm from the existence of a provision that offers them a lawful choice between buying insurance or doing nothing. The brief also argues that the plaintiffs also lack standing because there is no evidence that the amended provision will require them to spend more money.

Lastly, the court, according to the brief, wrongly concluded that the minimum coverage provision was unconstitutional, and even if it were there would be no legal basis for also declaring the rest of the ACA invalid—including its provisions expanding Medicaid, reforming Medicare, and providing protections to individuals with preexisting health conditions.

The case is currently pending before the Fifth Circuit Court.