Roughly 3.5 million Marylanders could lose their health insurance or face higher premiums due to their age, gender or a pre-existing condition because the Trump administration has decided not to enforce provisions of the federal law known as Obamacare, a new congressional report has found.
The decision by the U.S. Justice Department not to defend pillars of the Affordable Care Act against lawsuits fulfills a Republican promise to take steps to dismantle the law.
Some conservatives argue such protections penalize the healthy with higher premiums and are unconstitutional. But the decision also has the potential to restore roadblocks that prevent people from being able to buy health insurance, said Rep. Elijah Cummings,a Baltimore Democrat, who requested the report prepared by the Democratic staff of the Committee on Oversight and Government Reform.
The administration’s decision could open the doors for insurers to deny coverage to someone for having an illness such as cancer or a chronic condition like diabetes, or even being overweight, he said.
“You are going to see a lot more sick people who will not be able to get insurance,” said Cummings, ranking minority member on the committee. “The Trump administration has made it its business to dismantle the Affordable Care Act. Attacking the protections for people with pre-existing conditions will have a tremendous impact on people here in Maryland.”
The Justice Department in June called the provisions that prevented insurers from charging more — or denying coverage — to people with previous illnesses unconstitutional. The department’s objections were in a brief filed as part of a Texas lawsuit brought by Republican-led states alleging the whole health bill is unconstitutional.
The lawsuit led by Texas Attorney General Ken Paxton is pending in court and for now the protections remain in place.
The pre-existing condition protections have bipartisan support in some states, including Maryland.
State Attorney General Brian Frosh, a Democrat, sued the Trump administration to halt dismantling of the health bill.
Julia Nista, a spokeswoman for Rep. Andy Harris, a doctor and the only Republican in the Maryland delegation, called the congressional report “partisan,” but said the congressman disagrees with the Trump administration’s decision to not defend the protections.
Republican Gov. Larry Hogan was among a group of governors that denounced the attack on pre-existing conditions last summer. “The governor has repeatedly expressed his opposition to any action by the federal government that could cause Marylanders to lose health care coverage, and has made it clear that he expects the administration and members of Congress from both parties to come together and find common sense solutions,” spokeswoman Amelia Chasse said.
The congressional report requested by Cummings found that 167,000 Marylanders who buy individual health plans have a pre-existing illness that could affect their coverage.
The report found 160,000 women in the individual market could face higher costs or a loss of coverage because of their gender. Before the ACA, for instance, a 40-year-old Maryland woman paid 21 percent to 39 percent more for insurance than a man of the same age. About 108,000 older Marylanders between the ages of 50 and 64 could be charged 10 times more than younger adults, the report found.
The report warned that elimination of protections eventually could result in cuts to people who get insurance outside Obamacare, possibly affecting nearly 3.2 million Marylanders with employee-sponsored plans.
Karen Pollitz, a senior fellow with the Kaiser Family Foundation, said any cuts in the protections could go beyond just those covered under the ACA.
“It would be hard for those insurers to continue to offer plans that take everybody and charge the same if the competition stopped doing that,” Pollitz said. “Nobody has really estimated this, but people with really serious pre-existing conditions would probably get turned away.”
Harris does take issue with the assertion that Marylanders would lose insurance, noting protections in state law, Nista said.
She said the report likely doesn’t take into account a new one-year program in Maryland that creates a reinsurance pool to provide funding for catastrophic claims. Hogan and Democratic lawmakers worked together to pass the law to prevent the ACA from collapsing in Maryland.
“That reinsurance program actually resulted in lower, not higher, premiums for Marylanders with pre-existing conditions, regardless of what action the courts take in the federal case,” Nista said.
Doug Badger, a visiting fellow with the conservative think tank The Heritage Foundation, said state law would require coverage of pre-existing conditions no matter what a judge decides.
“Even if a judge were to invalidate federal pre-existing condition protections, it would have no effect in Maryland because the legislature has written these consumer protections into its state law,” Badger said. “The pre-existing condition and other consumer protections will remain in effect in Maryland, regardless of what the courts do with the federal law.”
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But one report said state law doesn’t offer enough protection.
A recent report by The Commonwealth Fund, a New York-based nonprofit that promotes better health care, concluded that Maryland does not have statutes at the state level to protect individual market consumers with pre-existing conditions, and Marylanders with pre-existing conditions could be affected by the Texas case.
If the Trump administration is successful in the Texas case, the impact of that legalized discrimination on costs for people with pre-existing conditions will not be cushioned by the state’s reinsurance program, a Cummings spokeswoman said.
Beth Sammis, president of advocacy group Consumer Health First, said she remembers when people were denied coverage when they suffered with illnesses and needed it the most. She said maintaining these protections is crucial in keeping Maryland healthy.
“I hope that at the end of the day cool heads will prevail and we will make it so that we are not going back to the days when people had to worry about if they had health care,” Sammis said.
Barbara Gruber said she is a “walking pre-existing condition.” The 60-year-old has asthma, coronary artery disease and autoimmune disorders. She used to have trouble getting health coverage and would often end up paying exorbitant premiums when she did. She worries about being put in that position again if the protections are taken away.
“It if goes back to the way it was, I might end up with no insurance, in the emergency room and declaring bankruptcy,” she said.