Pre-existing conditions Archives — Protect Our Care

Protect Our Care Commends Speaker Pelosi, House Democrats For Introducing Aggressive Legislation On Health Care

Washington, DC — After Speaker Pelosi and House Democrats announced they will be unveiling sweeping legislation on Tuesday aimed at protecting Americans with pre-existing conditions, lowering premiums and stopping the Trump Administration’s health care sabotage, Protect Our Care chair Leslie Dach released the following statement:

“Protect Our Care strongly supports efforts by House Democrats to protect people with pre-existing conditions, lower costs, improve care, and push back on the Trump Administration’s reckless acts of sabotage. In November, the American people said they want aggressive action, and the legislation Democrats are unveiling on Tuesday is a giant step in that direction. It stands in stark contrast to President Trump’s ongoing war on America’s health care and his budget that cuts Medicaid and Medicare by nearly two trillion dollars and ends protections for people with pre-existing conditions by repealing the Affordable Care Act.”


Protect Our Care Statement On World Cancer Day

Washington DC — Today, the world comes together once again to recognize World Cancer Day. As we unite our voices to raise awareness, we also call on the Administration to end their attacks on pre-existing conditions and affordable comprehensive health care for cancer patients and survivors. Leslie Dach, chair of Protect Our Care, issued the following statement:

“Sadly, cancer has devastated the lives of millions of Americans and has left many wondering how they’ll access and pay for their life-saving care. Over the past two years, President Trump has worked nonstop to sabotage protections for coverage for pre-existing conditions, making life even more difficult for cancer patients and survivors.  The GOP lawsuit to “terminate” the ACA is President Trump’s latest attempt to roll back the clock and strip Americans of their health care. If this misguided ruling isn’t overturned, Republicans will succeed in striking down the ACA and gutting key protections for millions of Americans. On this World Cancer Day, Trump and his Republican allies ought to end their war on pre-existing conditions and instead put their efforts into fighting the war on cancer.”


  • As Outlined In An Amicus Brief Written By The American Cancer Society, The Affordable Care Act Has Increased Cancer Patients’ Access To Potentially Life-Saving Health Care. However, the ACA greatly improved this situation.  After the ACA was enacted, the uninsured rate among nonelderly patients with newly diagnosed cancer declined substantially, especially among low-income people who resided in Medicaid expansion states—where it decreased 6 percent. This increase in coverage affects health outcomes—a small but statistically significant shift was found toward early-stage diagnosis for colorectal, lung, female breast, and pancreatic cancer and melanoma in patients in expansion states. Similarly, the ACA coverage expansion for dependent children up to age 26 has increased the insurance coverage rate among that population, had positive effect on initiation and completion of the human papillomavirus (HPV) vaccination, early diagnosis and receipt of fertility-sparing treatments for cervical cancer, and increased early-stage diagnosis for total cancer and osseous and chondromatous neoplasms among young adults 19 to 25 years old. The proportion of cancer survivors reporting delayed or forgone care and inability to afford health care services also significantly decreased during implementation of the ACA from 2010 to 2016. Overall, the uninsured rate for cancer survivors decreased from 12.4 percent (pre-full ACA implementation, 2012) to 7.7 percent (post-full ACA implementation, 2015).” [American Cancer Society, 6/14/18]
  • Similarly, The Affordable Care Act’s Medicaid Expansion Has Helped Cancer Patients See Increased Coverage For Care. “The number of uninsured cancer patients dropped in both expanded and non-expanded states from 2011 to 2014, but expansion states experienced a steeper decline. In expanded states, the uninsured rate declined a relative 52 percent, from 4.4 to 2.1 percent while Medicaid enrollment rose from 15.2 to 18.0 percent (p < 0.0001). In non-expansion states, the uninsured rate dropped a relative five percent (8.4 to 8.0 percent).”  [American Society For Radiation Oncology, 9/25/17]
  • In Kentucky, Medicaid Expansion Was Associated With Earlier Diagnosis And Somewhat Improved Breast Cancer Care. “The expansion of Kentucky Medicaid in 2014 has been associated with earlier diagnosis and somewhat improved quality of breast cancer care, despite a stable disease incidence. Additional improvements in treatment expediency will require improvements in patient outreach and healthcare infrastructure.” [Journal of the American College of Surgeons, April 2018]

Protect Our Care Statement on Today’s Ways & Means Committee Hearing On Pre-existing Conditions Protections

Washington DC — Today, the Ways and Means Committee held a hearing on Protecting Americans with Pre-existing Conditions. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in reaction to today’s committee hearing:

“We congratulate Chairman Neal and House Democrats for kicking off the Health Care Congress with the issue that brought them into the majority – affordable access to health care and, specifically, protecting people with pre-existing conditions from discrimination by insurance companies. It is heartening to hear so many members committed to maintaining and strengthening protections for people with pre-existing conditions. Today’s discussion sends a strong signal that House Democrats are focused on eliminating threats like junk plans and doing more to lower the cost of care for Americans. Voters put Democrats in the majority in the House to protect and improve their care.  Democrats understand they have a responsibility to deliver. If today’s hearing is any indication, they have every intention of doing so.”

Wisconsin Governor Fights Back Republicans Attempts To Weaken Protections For Pre-existing Conditions

Washington DC —  Republicans in the Wisconsin Senate are attempting to pass new legislation that falsely claims to ensure protections for people with pre-existing conditions continue, despite their efforts to invalidate them in federal court. Leslie Dach, chair of Protect Our Care issued the following statement in response:

“Republicans efforts in Wisconsin to push a bill that allows lifetime limits and annual caps on health care coverage is a travesty. Calling this bill any sort of ‘protection’ for people with pre-existing conditions is a fraud. Governor Evers rightly pledged to fully defend his constituents who have pre-existing conditions by vowing to oppose any legislation that rolls back protections for Wisconsinites. Let’s be clear: AB 1 would roll back the clock on vital protections and take Wisconsin back to the days where insurance companies could write the rules.”


What Policies Would Actually Ensure Pre-existing Conditions Are Protected?

  1. Guaranteed Issue and Community Rating: Forbids insurance companies from denying coverage based on health status or charging more.
  2. Essential Health Benefits: Required coverage benefits that help consumers with common health needs and prevent insurers from cutting benefits to lower costs.
  3. Prohibitions On Lifetime And Annual Limits: Prevents insurance companies from saying a consumer has maxed out their benefits in a given year.
  4. Prohibitions On Pre-existing Condition Exclusions: Insurance companies must not be able to sell coverage that can exclude coverage for certain conditions, such as cancer, diabetes, or asthma.


The language of the bill does nothing to prevent insurance companies from reinstating annual and lifetime limits that insurers use to restrict the amount of coverage someone can use.

The bill does not preserve the Affordable Care Act’s essential health benefits, essentially allowing insurers to sell plans exempt from covering basic services like maternity care, hospitalization, and prescription drugs.

Absent these protections, an insurance company could sell coverage to a cancer patient but refuse to cover their hospitalization or prescription drugs and drop their coverage once they reach their lifetime limit.

The bill does nothing to withdraw Wisconsin’s support for the Texas lawsuit that would eliminate the Affordable Care Act and its current protections for people with pre-existing conditions.



2,435,700 Wisconsinites Live With A Pre-Existing Condition. About one in two Wisconsinites, 51 percent, lives with a pre-existing condition. [Center for American Progress, 4/5/17]

1,187,000 Wisconsin Women And Girls Have A Pre-Existing Condition. Approximately 1,187,000 women and girls in Wisconsin live with a pre-existing condition. [Center for American Progress and the National Partnership For Women and Families, June 2018]

308,100 Wisconsin Children Already Have A Pre-Existing Condition. Roughly 308,000 Wisconsinites below age 18 live with a pre-existing condition. [Center for American Progress, 4/5/17]

616,900 Older Wisconsinites Live With A Pre-Existing Condition. 616,900 Wisconsin adults between the ages of 55 and 64 live with at least one pre-existing condition, meaning attacks on these protections significantly threaten Wisconsinites approaching Medicare age. [Center for American Progress, 4/5/17]



Because Of The Affordable Care Act, Insurance Companies Can No Longer Deny Coverage Or Charge More Because Of Pre-Existing Conditions. Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a ‘pre-existing condition’ — that is, a health problem you had before the date that new health coverage starts.” [HHS]

The ACA Outlawed Medical Underwriting, The Practice That Let Insurance Companies Charge Sick People And Women More. As the Brookings Institution summarizes, “The ACA outlawed medical underwriting, which had enabled insurance carriers to court the healthiest customers while denying coverage to people likely to need costly care. The ACA guaranteed that all applicants could buy insurance and that their premiums would not be adjusted for gender or personal characteristics other than age and smoking.”

The ACA Stopped Companies From Charging Women More Than Men For The Same Plan. The Affordable Care Act eliminated “gender rating,” meaning American women no longer have to pay an aggregated $1 billion more per year than men for the same coverage.

Thanks To The Affordable Care Act, Insurance Companies Can No Longer Rescind Coverage Because of Illness. Because of the ACA, insurance companies can no longer rescind or cancel someone’s coverage arbitrarily if they get sick.



A Public Policy Polling election day survey of Wisconsin voters found that health care was the top issue for voters in the state and that they overwhelmingly favored Democrats on it, propelling Tony Evers to victory.

  • 68% of voters said that health care was either a very important issue or the most important issue to them. Those voters supported Evers over Scott Walker 65-33.
  • When asked to name the single issue most important to them in 2018, a plurality (27%) picked health care. Among those voters who said health care was their single most important issue in the election, Evers defeated Walker by a whopping 89-7 margin.
  • Evers especially had an advantage over Walker when it came to the issue of who voters trusted more to protect people with pre-existing conditions. 50% preferred Evers to protect pre-existing conditions to only 41% who preferred Walker.
  • Scott Walker’s support for the Republican health care repeal agenda hurt him badly. Only 32% of voters said his support for repeal made them more likely to vote for him, while 47% said it made them less likely to support him.
  • An overwhelming majority of Wisconsinites want to see the Affordable Care Act stay in place – 62% think it should be kept with fixes made to it as necessary, compared to only 32% of voters who support repealing it.

CMS Proposal is the Trump Administration’s Latest Act Of Health Care Sabotage

The Payment Notice Cuts Premium Tax Credits By $1 Billion Annually, Slashes Coverage, Increases Out-Of-Pocket Costs, And Puts People With Pre-existing Conditions At Risk


Last night, the Centers for Medicare & Medicaid Services (CMS) issued the proposed annual Notice of Benefit and Payment Parameters (NBPP) for the 2020 benefit year, which outlines regulatory and financial guidelines applicable to exchange plans. The proposal from CMS would do the following:

  • Cut premium tax credits by $1 billion per year ($900M in 2020 and 2021, $1 billion in 2022 and 2023)
  • Cause 100,000 people to lose marketplace coverage annually starting in 2020
  • Increase annual premiums by $189 for a family of four at 300 percent of poverty
  • Increase the maximum out-of-pocket costs by $400 for a family (from $16,000 without the change to $16,400 with it) and $200 for an individual (from $8,000 annually to $8,200 annually).

“Despite the lessons of the 2018 midterm elections, the Trump administration is continuing its relentless efforts to sabotage health care for millions of Americans,” said Leslie Dach, chair of Protect Our Care. “They want to increase premiums, put protections for people with pre-existing conditions further at risk, and rip affordable coverage from countless Americans. It’s time they start improving our health care and stop ripping it apart.”

Here’s a look at what the Administration’s proposal would mean for people across the country, according to health care experts and CMS itself:

The Payment Notice Means Higher Premiums, Less In Subsides, And A Drop In Enrollment. “The Trump administration estimates that their proposed change to how ACA premium subsidies are calculated would increase consumer premiums by $181 million and decrease marketplace enrollment by 100,000. As a result, the government would save $900 million.” [Larry Levitt, 1/17/19]

The Provisions Of The Payment Notice Would Reduce Americans’ Premium Tax Credits By Roughly $1 Billion Annually, Leading A Family Of Four At 300 Percent Of The Federal Poverty Line To Pay $189 More Annually. As Matt Fielder, Fellow at the USC-Brookings Schaeffer Initiative for Health Policy concludes: “In dollar terms, single person at 300% of FPL would lose $92/year in [premium tax credits]; family of four at 300% of FPL would lose $189/year in [premium tax credits]. Smaller effects at lower income levels and larger effects at higher income levels. In the aggregate, CMS Actuary estimates proposed change would result in $900m less in tax credit payments and 100,000 fewer Marketplace enrollees in 2020.” [Matt Fiedler, 1/17/19]

The Rules Would Also Increase The Maximum Out Of Pocket Costs In All Private Insurance Plans, By $200 For Individuals And $400 For A Family. “A technical change proposed by the Trump administration would result in maximum consumer out-of-pocket costs in all private insurance plans going up to $8,200 per person in 2020 instead of $8,000. To be clear, either amount is out of reach for many people.” The rule would also increase the maximum out of pocket costs for families from $16,000 to $16,400. [Larry Levitt, 1/17/19; Centers on Medicare And Medicaid Services, 1/17/19

100,000 People Would Lose Marketplace Coverage Each Year Beginning In 2020. [CMS, 1/17/19]

The Administration Has Also Invited Public Comment On Two Parameters — Eliminating Silver-Loading And Automatic Reenrollment. “One change the Trump administration is inviting comment on could eliminate automatic renewal of ACA marketplace coverage and premium subsidies. This year 1.8 million people were automatically re-enrolled in states using the federal marketplace. Another change the Trump administration is inviting comment on could eliminate “silver loading,” where insurers increased premiums for silver plans to offset the termination of cost-sharing subsidy payments to those insurers by the administration. Prohibiting “silver loading” of premiums in the ACA marketplace would lower government costs, but it would increase out-of-pocket premiums for many subsidized enrollees and also increase premiums for middle-class consumers not eligible for subsidies.” [Larry Levitt, 1/17/19]

Andy Slavitt, Former Head Of CMS: “Undermining Obamacare Is The Only Conceivable Reason To Dismantle [Auto-reenrollment].” “Auto reenrollment is simple. It means that like most employer coverage, if you forget to sign up for coverage, yours won’t get taken away. With auto-reenrollment, you can still reject coverage by not paying the bill. 1.8 million use it every year to keep continuous coverage. What happens if it’s taken away? You forget to sign up by 12/15. Get a cancer diagnosis in January. Not covered. With auto-[reenrollment], covered. It’s already automated, and how people are used to operating. Undermining Obamacare is the only conceivable reason to dismantle this.” [Andy Slavitt, 1/17/19]

The Payment Notice Allows States To Select An Essential Health Benefits (EHB) Package Used By Another State, Making EHBs More Flexible And Making It Easier For States To Not Cover All Of The Needs Of People With Pre-existing Conditions. “In the 2019 Payment Notice, we finalized options for states to select new EHB benchmark plans starting with the 2020 benefit year. Under 45 CFR 156.111, a state may modify its EHB-benchmark plan by: (1) Selecting the EHB-benchmark plan that another state used for the 2017 plan year; (2) Replacing one or more EHB categories of benefits in its EHB-benchmark plan used for the 2017 plan year with the same categories of benefits from another state’s EHB-benchmark plan used for the 2017 plan year; or (3) Otherwise selecting a set of benefits that would become the state’s EHB-benchmark plan.” [CMS, 1/17/19]

Legislators are calling the changes out for what they are: sabotage.

Sen. Ron Wyden (D-OR), Ranking Member Of Senate Finance Committee: “Today’s Proposed Rule Deliberately And Needlessly Increases Premiums And Will Result In Too Many Americans Losing Coverage.” “Trump’s health care sabotage agenda is defined by higher premiums for families and bureaucratic barriers that make it harder to find health coverage. Today’s proposed rule deliberately and needlessly increases premiums and will result in too many Americans losing access to health coverage. It’s no wonder Americans are so fed up with America’s health care system when the Trump administration continues to fan the flames of uncertainty while families pick up the check.” [Wyden Statement, 1/17/19]

Sen. Patty Murray (D-WA), Ranking Member Of The Senate Health, Education, Labor, And Pensions (HELP) Committee: “Even 27 Days Into The Shutdown He Caused, President Trump Has Somehow Found Time To Further Sabotage Health Care For Patients, Families, And Women.” “Even 27 days into the shutdown he caused, President Trump has somehow found time to further sabotage health care for patients, families, and women — this time by proposing what would amount to a health care tax on patients and families across the country. President Trump is hurting families left and right and Democrats are going to keep holding him accountable.” [Murray Statement, 1/17/19

Shelley Moore Capito Suddenly Supports the Affordable Care Act

Facing re-election, Sen. Shelley Moore Capito (R-WV) is now telling voters one thing while consistently having done the opposite. This morning, she told the Los Angeles Times she supports maintaining protections for people with pre-existing conditions and letting children stay on their parents’ insurance until age 26, two main provisions of the Affordable Care Act. Where has this been for the previous two years?

SHOT: “I think it would be in our best interest as Republicans to assure the public that [on] the issues like preexisting conditions, staying on your parents’ insurance until age 26 and things like that, we’re committed,” said Sen. Shelley Moore Capito, who is up for reelection in West Virginia in 2020.” [Los Angeles Times, 12/30/18]

CHASER: Sen. Capito voted to fully repeal the ACA as a House Member, which would have repealed provisions to protect people with pre-existing conditions and allow kids to stay on their parents’ coverage until age 26. And she voted to repeal the ACA as a Senator last summer.

In 2011, Rep. Shelley Moore Capito Voted For A Full Repeal Of The ACA, “Repealing the Job-Killing Health Care Law Act.” [House clerk, 1/19/11]

In 2012, Rep. Shelley Moore Capito Again Voted For A Full Repeal Of The ACA. [House clerk, 7/11/12]

In 2017, Sen. Shelley Moore Capito Voted For The Better Care Reconciliation Act, Which Would Kicked 22 Million Americans Off Of Their Insurance. [New York Times, 7/28/17; Congressional Budget Office, 6/26/17]

In 2017, Sen. Shelley Moore Capito Also Voted For The GOP’s Final Repeal Bill. [New York Times, 7/28/17]. As a reminder, under repeal:

  • 184,000 West Virginians would lose health coverage, a 208% increase in the number of uninsured. [Urban Institute]
  • West Virginians would lose $1.794 billion in federal financial assistance through the insurance marketplaces from 2019-2028, leading to a dramatic spike in the number of uninsured. [Urban Institute]
  • 29,163 West Virginians would lose an average monthly advanced premium tax credit of $388 which currently helps them pay for insurance [Kaiser Family Foundation]
  • West Virginia would lose $12.2 billion in federal Medicaid or Children’s Health Insurance Program (CHIP) funding, currently providing lifelines to 562,183 West Virginians. [Urban Institute, Kaiser Family Foundation]
  • Repealing the ACA would result in 16,000 West Virginia jobs lost, including 7,200 jobs in the healthcare sector. [Commonwealth Fund]

“The Assurances Are Worthless”: Editorials From Coast to Coast Hammer Republicans Over Latest Attack on the Affordable Care Act

On Friday night, hand-picked, conservative, right-wing federal District Court Judge Reed O’Connor ruled the entire Affordable Care Act unconstitutional. His decision would end protections for people with pre-existing conditions, re-institute lifetime limits on coverage, implement an age tax on older Americans, end Medicaid expansion, and take away coverage from tens of millions of Americans. In short, an absolute disaster for Americans and their health care – and editorials across the country have been quick to note make this clear. Here’s a sampling:

The ruling has been criticized by editorial boards:

Los Angeles Times: “The Relentless, Wreck-It-Ralph Attacks On The Law In Congress And The Courts Should Have Ended Last Year.” “ By handing a victory to 18 Republican state attorneys general and two Republican governors, however, the judge has threatened to put healthcare out of reach for millions of lower-income Americans, undo important insurance reforms and toss out federal efforts to improve the cost and quality of care. The ruling will be appealed and has no immediate effect. Yet by issuing it before the end of open enrollment, Judge Reed O’Connor needlessly sowed confusion and, potentially, discouraged some people from obtaining coverage for 2019. That’s unforgivable. Worse yet, it could result in the entire law being tossed out by the courts. We get it — there are plenty of Republicans who don’t like major features of the ACA and resent the way it was enacted. But the relentless, Wreck-It-Ralph attacks on the law in Congress and the courts should have ended last year, when Republicans could get neither a pure repeal nor a repeal-and-replace plan through the Congress they controlled even on a simple majority vote.” [Los Angeles Times, 12/15]

Bloomberg: Republican Assurances On Pre-Existing Conditions “Were Worthless.” “‘Everybody I know in the Senate — everybody — is in favor of maintaining coverage for pre-existing conditions,’ Senate Majority Leader Mitch McConnell said in June. ‘All Republicans support people with pre-existing conditions, and if they don’t, they will after I speak to them. I am in total support,’ President Trump tweeted in October. This was during the midterm election campaign, when the Republicans were pedaling backward to convince America that they’d no intention of taking away the protections of the Affordable Care Act. Ignore the efforts in Congress to repeal the law, they told voters; don’t worry about the Justice Department joining a legal challenge to ACA, asking to strike down coverage of people with preexisting conditions at no extra cost. The assurances were worthless. A court has not only thrown out protections for preexisting conditions; it has ruled the ACA as a whole unconstitutional — including the Medicaid expansion, the requirement that large employers offer health-insurance benefits, the subsidies for low-income buyers of insurance on the health exchanges, even the exchanges themselves.” [Bloomberg, 12/16]

It has been assailed by legal experts:

Jonathan Adler and Abbe Gluck, New York Times: “This Decision Makes A Mockery Of The Rule Of Law And The Basic Principles Of Democracy.” “A ruling this consequential had better be based on rock-solid legal argument. Instead, the opinion by Judge Reed O’Connor is an exercise of raw judicial power, unmoored from the relevant doctrines concerning when judges may strike down a whole law because of a single alleged legal infirmity buried within. We were on opposing sides of the 2012 and 2015 Supreme Court challenges to the Affordable Care Act, and we have different views of the merits of the act itself. But as experts in the field of statutory law, we agree that this decision makes a mockery of the rule of law and basic principles of democracy — especially Congress’s constitutional power to amend its own statutes and do so in accord with its own internal rules.” [New York Times, 12/15]

Nicholas Bagley, Washington Post: “Don’t Mistake [This Ruling] For The Rule Of Law.” “To put it bluntly, [the ruling] makes zero sense… In perhaps the most remarkable passage in a remarkable opinion, he wrote that the 2017 Congress ‘intended to preserve the Individual Mandate because the 2017 Congress, like the 2010 Congress, knew that provision is essential to the ACA.’ Your jaw should be on the floor. On no account did Congress in 2017 ‘intend to preserve’ the individual mandate. It meant to get rid of the loathed mandate — and it did, by eliminating the penalty that gave it force and effect… So nothing changes for the time being. And nothing should change. The legal arguments in previous rounds of litigation over the ACA may have been weak, but they were not frivolous. This case is different; it’s an exercise of raw judicial activism. Don’t for a moment mistake it for the rule of law.” [Washington Post, 12/16]

Cristan Farias, New York Times: “Shocking Even Conservative Legal Experts, The Trump Administration Lent Its Support To The Texas Lawsuit.” “The ruling, issued late on Friday and only one day before the end of the law’s annual open enrollment period, is not a model of constitutional or statutory analysis. It’s instead a predictable exercise in motivated reasoning — drafted by a jurist with a history of ruling against policies and laws advanced by President Barack Obama… Shocking even conservative legal experts, the Trump administration fell for this spurious argument and lent its support to the Texas lawsuit — which, if successful, would render all of the marquee provisions of Obamacare, like protections for patients with pre-existing conditions, null… This all-out assault on health care is one reason Democrats did so well in the midterm elections, as voters rejected anti-Obamacare candidates at the polls. They included several lawmakers who had gleefully voted for Mr. Trump’s tax bill less than a year earlier.” [New York Times, 12/15]

And its drastic consequences have been made clear:

Jonathan Gruber, Boston Globe: “If This Law Is Struck Down, We Will Return To The Bad Old Days Where Insurers Could Deny Coverage To Individuals Who Are Ill.” “Even though the Trump administration has significantly weakened the ACA, 17 million Americans have gained coverage through the law. Perhaps more importantly, the estimated 133 million Americans with a pre-existing condition have access to affordable coverage should they need it. If this law is struck down, we will return to the bad old days where insurers could deny coverage to individuals who are ill, or charge them many times more than the healthy. That’s not all that will be lost with a repeal of the ACA. Children will no longer be protected by their parents’ insurance plans until age 26. Insurers will be able to once again limit how much healthcare spending they cover in any year, and there will no longer be a cap on what individuals have to spend out of pocket on their medical costs. Millions of Americans who don’t read the fine print of their insurance contracts could once again buy insurance that leaves them with tens of thousands of dollars in uncovered medical bills.” [Boston Globe, 12/15]

  • Gruber: “It Isn’t Just The Health Of Our Citizens That Is At Risk Here – It Is The Health Of Our Democracy.” “But it isn’t just the health of our citizens that is at risk here – it is the health of our democracy. We have a law that was first passed when Democrats controlled both houses of Congress and the presidency. It was then thoroughly reviewed, debated, and voted on when the Republicans controlled both houses of Congress and the presidency. The Republicans decided that the proper outcome was an ACA with no mandate, and the outcome of that process was a weaker but still functional ACA. If the courts overturn this outcome, it is an attack on the very process of representative government in the US.” [Boston Globe, 12/15]

Evan Mintz, Houston Chronicle: We’ll Wait To See Whether Insurance Companies Will Once Again Be Allowed To Discriminate Against People With Pre-existing Conditions Or Sell Plans That Don’t Cover Core Medical Needs.” “This district court didn’t issue an injunction, so the nation will have to wait for the inevitable appeals to see if we lose all the protections in the groundbreaking law. We’ll wait to see whether insurance companies will once again be allowed to discriminate against people with pre-existing conditions or sell plans that don’t cover core medical needs. Millions of Americans are left wondering if our nation is going to be thrust back into an age before the ACA, also known as Obamacare, when medical bankruptcies were skyrocketing and people were afraid to change their jobs for fear being denied coverage. If you’re one of these Americans, feel free to thank Texas Attorney General Ken Paxton, who led the plaintiffs in the lawsuit. Paxton — who is currently under indictment for fraud — now bears the burden of helping his fellow Texans understand what happens if the ACA is eventually struck down for good.” [Houston Chronicle, 12/16]

Derek Rapp, The Hill: This Ruling “Threatens Coverage Of Pre-Existing Conditions [And] Leaves MIllions In Jeopardy.” “Coverage for pre-existing conditions is critical for the millions of Americans living with chronic diseases, and it’s a matter of decency and existing law. Until the Affordable Care Act, people with pre-existing conditions were denied insurance coverage, charged higher premiums and offered limited benefits. Friday’s decision by a federal judge in Texas that threatens coverage of pre-existing conditions leaves millions in jeopardy a month after the topic dominated the midterm elections.” [The Hill, 12/15]

As millions of Americans go to bed tonight anxious about the future of their health care, whether this country will return to the days of discrimination against those with pre-existing conditions and denied coverage claims and surprise medical bankruptcies, Donald Trump and Congressional Republicans will continue to own every last worry.

Court Sides with Trump and Republicans and Rules to Overturn the Affordable Care Act: Here are the Facts

For the past two years, Republicans have been waging a relentless war on health care trying to repeal the Affordable Care Act (ACA). Last night, Republicans got their wish when U.S. Northern Texas District Court Judge Reed O’Connor sided with Republican lawmakers in 20 states and invalidated the ACA in its entirety. With this decision, Republicans are close to doing through the Courts what they failed to do legislatively: repeal our health care, which will rip coverage from millions of Americans, raise costs, end protections for people with pre-existing conditions, put insurance companies back in charge, and force seniors to pay more for prescription drugs.

The ruling is legally wrong and must be overturned. If not, this ruling will, as the Trump Administration itself admitted in Court, unleash “chaos” in our entire health care system.

Thanks To The Republican Lawsuit, 17 Million People Could Lose Their Coverage

Republicans Convinced The Court To Put Insurance Companies Back In Charge, Ending Protections For The 130 Million People With A Pre-Existing Condition

  • According to a recent analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 130 million people, have a pre-existing condition. This includes:
    • 44 million people who have high blood pressure
    • 45 million people who have behavioral health disorders
    • 44 million people who have high cholesterol
    • 34 million people who have asthma and chronic lung disease
    • 34 million people who have osteoarthritis and other joint disorders
  • 17 million children. One in four children, or roughly 17 million, have a pre-existing condition.
  • 68 million women. More than half of women and girls nationally have a pre-existing condition.
  • 30 million people aged 55-64. 84 percent of older adults, 30.5 million Americans between age 55 and 64, have a pre-existing condition.

Republicans Convinced The Court To Give Insurance Companies The Power To Deny Or Drop Coverage Because Of A Pre-Existing Condition

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. Now insurance companies have license to do this again.

  • A 2010 congressional report found that the top four health insurance companies denied coverage to one in seven consumers on the individual market over a three year period.
  • A 2009 congressional report found that the of the largest insurance companies had retroactively canceled coverage for 20,000 people over the previous five year period
Conditions That Could Cost You Your Care:

  • Alcohol/drug Abuse
  • Cerebral Palsy
  • Cancer
  • Heart Disease
  • Diabetes
  • Epilepsy
  • Kidney Disease
  • Severe Epilepsy
  • Sleep Apnea
  • Pregnancy
  • Muscular Dystrophy
  • Depression
  • Eating Disorders
  • Bipolar Disorder
Jobs You Could Be Denied Coverage Because Of:

  • Active military personnel
  • Air traffic controller
  • Body guard
  • Pilot
  • Meat packers
  • Taxi cab drivers
  • Steel metal workers
  • Law enforcement
  • Oil and gas exploration
  • Scuba divers
Medications That You Could Be Denied Health Care For Taking:

  • Anti-arthritic medications
  • Anti-diabetic medications (including insulin)
  • Anti-cancer medications
  • Anti-coagulant and anti-thrombotic medications
  • Medications used to treat autism
  • Anti-psychotics
  • Medications for HIV/AIDS
  • Growth hormone
  • Medication used to treat arthritis, anemia, and narcolepsy
  • Fertility Medication

Republicans Convinced The Court To Give Insurance Companies The Power To Charge You More

  • More than 100 Million People With A Pre-Existing Condition Could Be Forced to Pay More. An analysis by Avalere finds that “102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs” thanks to the Republican lawsuit to repeal the Affordable Care Act.
  • Premium Surcharges Can Once Again Be In The Six Figures. Thanks to the Republican lawsuit, insurance companies can charge people more because of a pre-existing condition. The House-passed repeal bill had a similar provision, and an analysis by the Center for American Progress found that insurers could charge up to $4,270 more for asthma, $17,060 more for pregnancy, $26,180 more for rheumatoid arthritis and $140,510 more for metastatic cancer.
  • Women Can Be Charged More Than Men For The Same Coverage. Prior to the ACA, women, for example, were often charged premiums on the nongroup market of up to 50 percent higher than they charged men for the same coverage.
  • People Over The Age of 50 Can Face A $4,000 “Age Tax.” Thanks to the Republican lawsuit, insurance companies can charge people over 50 more than younger people. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the Republican repeal bills, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, according to the AARP.
  • Nine Million People In The Marketplaces Will Pay More For Coverage. Thanks to the Republican lawsuit, consumers no longer have access to tax credits that help them pay their marketplace premiums, meaning roughly nine million people who receive these tax credits to pay for coverage will have to pay more.
  • Seniors Will Have To Pay More For Prescription Drugs. Thanks to the Republican lawsuit, seniors will have to pay more for prescription drugs because the Medicare “donut” hole got reopened. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 Centers on Medicare and Medicaid Services report.

Republicans Convinced The Court To Give Insurance Companies The Power To Limit The Care You Get, Even If You Have Insurance Through Your Employer

  • Reinstate Lifetime and Annual Limits. Thanks to the Republican lawsuit, insurance companies can once again impose annual and lifetime limits on coverage.
  • Insurance Companies Do Not Have to Provide the Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.

Republicans Convinced The Court To End Medicaid Expansion

  • Fifteen million people have coverage through the expanded Medicaid program.

“If The Trump Administration’s Argument Were to Prevail, Insurers Could Once Again Be Able to Flat-Out Deny Americans Insurance Based On Their Health Status”: Reactions to Judge Ruling to Fully Repeal Affordable Care Act

Tonight, hand-picked, conservative, right-wing federal District Court Judge Reed O’Connor ruled the entire Affordable Care Act unconstitutional. His decision would end protections for people with pre-existing conditions, re-institute lifetime limits on coverage, implement an age tax on older Americans, end Medicaid expansion, and take away coverage from tens of millions of Americans. In short, an absolute disaster for Americans and their health care.

His decision would cause irreparable harm to the nation’s health care system:

New York Times: 17 Million Americans Would Lose Their Health Insurance. “If Judge O’Connor’s decision ultimately stands, about 17 million Americans will lose their health insurance, according to the Urban Institute, a left-leaning think tank. That includes millions who gained coverage through the law’s expansion of Medicaid, and millions more who receive subsidized private insurance through the law’s online marketplaces” [New York Times, 12/14/18]

Vox: Americans Could Once Again Be Denied Coverage For Pre-Existing Conditions. “Usually, a presidential administration defends current law, but the Trump administration took a different approach in this case. It agreed with the conservative states that the mandate and, with it, the law’s rules that prohibits insurers from denying people health insurance or charging them higher rates, should be found unconstitutional…. If the Trump administration’s argument were to prevail, insurers could once again be able to flat-out deny Americans insurance based on their health status. No amount of federal subsidies would protect them. Medicaid expansion would remain, but the private insurance market would no longer guarantee coverage to every American.” [Vox, 12/14/18]

Texas Tribune: Ruling “Could Throw The Nation’s Health Care System Into Chaos.” “In a ruling that could throw the nation’s health care system into chaos, Fort Worth-based U.S. District Judge Reed O’Connor on Friday ruled that a major provision of the Affordable Care Act is unconstitutional — and that the rest of the landmark law must fall as well…Legal scholars — even some conservatives who oppose the law — have nonetheless called Texas’ argument unconvincing.” [Texas Tribune, 12/14/18]

Larry Levitt, Kaiser Family Foundation: “If Upheld, This Would Throw Out Not Only The law’s Pre-Existing Condition Protections, But Also Everything Else.” “If upheld, this would throw out not only the law’s pre-existing condition protections, but also everything else — premium subsidies, expanded Medicaid, preventive services, and much more.” [Larry Levitt Twitter, 12/14/18]

His decision came following midterm elections in which health care carried Democrats to elected office across the country:

Politico: Decision Comes After Midterm Elections Which Partially Served “As A Rebuke To Republican Efforts To Tear Down Obamacare.” “The invalidation of the landmark 2010 law is certain to send shock waves through the U.S. health system and Washington after a midterm election seen in part as a rebuke to Republican efforts to tear down Obamacare.” [Politico, 12/14/18]

CNN: “Protecting Those With Pre-Existing Conditions Became A Central Focus Of [Midterm] Races.” “The lawsuit entered the spotlight during the midterm elections, helping propel many Democratic candidates to victory. Protecting those with pre-existing conditions became a central focus of the races. Some 58% of Americans said they trust Democrats more to continue the law’s provisions, compared to 26% who chose Republicans, according to a Kaiser Family Foundation election tracking poll released in mid-October.” [CNN, 12/14/18]

His decision came as open enrollment wraps up, underscoring the GOP’s obsession with sabotaging America’s health care system:

Bloomberg: Decision “Underscores A Divide Between Republicans Who Have Long Sought To Invalidate The Law And Democrats Who Fought To Keep It In Place.” “The decision Friday finding the Affordable Care Act unconstitutional comes just before the end of a six-week open enrollment period for the program in 2019 and underscores a divide between Republicans who have long sought to invalidate the law and Democrats who fought to keep it in place.” [Bloomberg, 12/14/18]

Washington Examiner: The Decision Came The Day Before The End Of Open Enrollment, Cementing the Trump Administration’s Sabotage Of The Marketplace. “The decision came just a day ahead of when the open enrollment for Obamacare’s marketplaces are set to close across most of the U.S. Enrollment in these marketplaces has been lagging, with some critics arguing that the zeroing out of the fine is partially to blame.” [12/14/18]

Axios: “Republicans Have Never Come Up With A Replacement Plan That Would Offer The Same Level Of Protection As The ACA.” “In an interview with “Axios on HBO,” President Trump said he’d reinstate protections for pre-existing conditions if the lawsuit gutted the ACA. But as Axios’ Sam Baker notes, Republicans have never come up with a replacement plan that would offer the same level of protection as the ACA.” [Axios, 12/14/18]

And his decision was written on questionable legal grounds:

The Hill: “Legal Experts In Both Parties Have Denounced [The Judge’s] Argument.” “In a controversial move, the judge added that because the mandate is ‘essential’ to the rest of the law, without the mandate, the entire law is invalid. Legal experts in both parties have denounced that argument, saying it is obvious that Congress wanted the rest of the Affordable Care Act to remain when it repealed only the mandate penalty last year.” [The Hill, 12/14/18]

Washington Post: “Many Health-Law Specialists Have Viewed Its Logic As Weak.” “A federal judge in Texas threw a dagger on Friday into the Affordable Care Act, ruling that the entire health-care law is unconstitutional because of a recent change in federal tax law….Since the suit was filed in January, many health-law specialists have viewed its logic as weak but nevertheless have regarded the case as the greatest looming legal threat to the 2010 law, which has been a GOP whipping post ever since and assailed repeatedly in the courts.” [Washington Post, 12/14/18]

Jonathan Cohn, HuffPost: “This Is A Breathtaking Ruling In Favor Of A Lawsuit That Even Conservative Legal Experts Have Trashed.” [Jonathan Cohn Twitter, 12/14/18]

Paul McLeod, Buzzfeed: When It Comes To Judicial Activism, “You Can’t Come Up With A Clearer Example Than This.” “Can’t stress enough that when we hear about ‘judicial activism’ you can’t come up with a clearer example than this. This judge overturned the will of Congress (technical details of why/how are in the story.) But legal experts I talked to described this interpretation as ludicrous.” [Paul McLeod Twitter, 12/14/18]

Experts were incredulous:

Nicholas Bagley, University Of Michigan Health Law Professor: “This Is Insanity In Print.” “The court’s decision is NOT limited to guaranteed issue and community rating. In the court’s view — and this is *absolutely* insane — the entire Affordable Care Act is unconstitutional…If you were ever tempted to think that right-wing judges weren’t activist — that they were only “enforcing the Constitution” or “reading the statute” — this will persuade you to knock it off. This is insanity in print, and it will not stand up on appeal.” [Nicholas Bagley Twitter, 12/14/18]

Timothy Jost, Washington And Lee University Law Professor: “It’s Timed To Cause Maximum Chaos.” “This is breathtaking in its sweep & I think O’Connor has no idea what he’s doing..This is going to get thrown out. But I also think it’s timed to cause maximum chaos.” [Emma Platoff, Texas Tribune Reporter, 12/14/18]

And here’s what elected officials said:

Speaker-Designate Nancy Pelosi (D-CA): “Tonight’s District Court Ruling Exposes The Monstrous Endgame Of Republicans’ All-out Assault On People With Pre-existing Conditions.” “Tonight’s district court ruling exposes the monstrous endgame of Republicans’ all-out assault on people with pre-existing conditions and Americans’ access to affordable health care. The GOP Congress tried and failed to destroy the Affordable Care Act and protections for pre-existing conditions.  Then, in the midterm election, the American people delivered a record-breaking margin of almost 10 million votes against House Republicans’ vile assault on health care. Now, the district court ruling in Republicans’ lawsuit seeks to subvert the will of the American people and sow chaos in the final day of HealthCare.gov open enrollment.” [Office Of The Speaker-Designate, 12/14/18]

House Ways & Means Ranking Member Richard Neal (D-MA), Energy and Commerce Ranking Member Frank Pallone, Jr. (D-NJ), and Education and the Workforce Committee Ranking Member Bobby Scott (D-VA): “It Is An Ideological Decision In A Case That Has No Legal Merit.” “This reckless court decision endangers the lives of millions of Americans who are going to lose their health care. It is an ideological decision in a case that has no legal merit.  Last month’s election results showed how important access to health coverage and protections for pre-existing conditions are for American families, and we are calling for an emergency stay of this heartless ruling. We will take immediate action in the new Congress to intervene in this case and appeal this decision. House Democrats will do whatever it takes to make sure the protections enshrined in the Affordable Care Act endure. The lives and wellbeing of millions of Americans – including those living with pre-existing conditions – are on the line.” [Ways and Means Democrats, 12/14/18]

Senate Minority Leader Chuck Schumer (D-NY): “If This Awful Ruling Is Upheld In The Higher Courts, It Will Be A Disaster For Tens Of Millions Of American Families.” “If this awful ruling is upheld in the higher courts, it will be a disaster for tens of millions of American families, especially for people with pre-existing conditions. The ruling seems to be based on faulty legal reasoning and hopefully it will be overturned. Americans who care about working families must do all they can to prevent this district court ruling from becoming law.” [Sen. Chuck Schumer Twitter, 12/14/18]

Sen. Chris Murphy (D-CT): “This Is A Five Fire Alarm — Republicans Just Blew Up Our Health Care System.” “This is a five alarm fire — Republicans just blew up our health care system. 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 preexisting conditions…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.” [Sen. Chris Murphy, 12/14/18]

Senate Finance Committee Ranking Member Ron Wyden (D-OR): “A Deliberate, Ideological Move To Sabotage The Affordable Care Act At The Expense Of Families’ Health Care.” “Today’s ruling is an assault on all Americans’ basic health care rights and judicial overreach at its worst. Trump and Republicans in Congress will achieve their long-sought goals if this ruling stands: the elimination of pre-existing condition protections and Medicaid coverage for millions of vulnerable Americans. Seniors will pay more for their prescriptions and middle-class families will lose tax breaks that keep their health care affordable. This judge chose to deliver his ruling the day before the end of open enrollment – a deliberate, ideological move to sabotage the Affordable Care Act at the expense of families’ health care.” [Sen. Ron Wyden, 12/14/18]



Protections for Pre-Existing Conditions Gone

Medicaid Expansion Gone

Women Charged More Because They Are Women

Seniors Pay More for Prescription Drugs

Health Care Coverage for Children Up to 26 Gone

Millions Could Lose Health Care

“This decision is a disaster for American health care and it should be reversed immediately. Republicans at all levels own full responsibility for the harm this decision will cause, if it’s allowed to stand,” said Leslie Dach

Washington, D.C. – In response to conservative U.S. District Judge Reed O’Connor’s ruling in Texas, et. al. vs. United States, et. al., a case brought by Republican attorneys general and governors and the Trump Administration, Leslie Dach, chair of Protect Our Care, issued the following statement:

“Today, Republicans got their wish: they have ripped health care away from millions of people and raised costs for millions more. This decision is a disaster for American health care and it should be reversed immediately by a higher court. But make no mistake: what this judge ruled is what Republicans asked for. Republicans at all levels own full responsibility for the harm this decision will cause if it’s allowed to stand.

“If this ruling is not overturned, Republicans will bring us back to a time when insurance companies could deny the millions of Americans living with pre-existing conditions — like cancer, diabetes, or asthma — health coverage altogether or jack up their premiums, making life-saving health care unaffordable for millions. It forces seniors to pay more for drugs and allows insurance companies to charge women and seniors more based on their age and gender. It eliminates Medicaid expansion for 15 million Americans.  

“Donald Trump, every single Republican attorney general and governor on this case, and every Republican in Congress and in statehouses who refused to publicly oppose this lawsuit are responsible for what happens next. They own this, and deserve the wrath of the American people who just weeks ago voted to protect our care.”


Under this ruling:

  • Seventeen million more people could lose their coverage in a single year, leading to a 50 percent increase in the uninsured rate
  • Protections for 130 million people with pre-existing conditions would be removed
  • Annual and lifetime limits would once again be legal
  • Children would no longer be allowed to stay on their parents’ insurance until age 26
  • Medicaid expansion, currently covering 15 million people, would end
  • Improvements to Medicare, including reduced costs for prescription drugs, would be eliminated
  • Insurance discrimination against women and people over age 50 would once again be allowed
  • Limits on out-of-pocket costs would be eliminated
  • Small business tax credits would no longer exist
  • Marketplace tax credits for up to 9 million people would end

Republicans at all levels own the consequences of this decision on the American people.

  • The Republican attorneys general and governors who brought this case have been hellbent on restricting people’s access to health care. Many of those involved in this lawsuit have been involved in prior efforts to dismantle the Affordable Care Act, block the Medicaid expansion and restrict women’s health.  
  • The Trump Administration took the shocking step of abandoning its legal and constitutional responsibilities to defend the law of the land, instead prioritizing its no-holds-barred war on American health care by siding with the Republican states in this case.
  • Republicans in Congress voted for the tax scam that opened the door for this lawsuit in the first place.
  • Republicans in Congress refused to join Democratic efforts in the Senate and House to intervene in this lawsuit to protect health care.
  • Republican governors who want to distance themselves from this lawsuit could have directed their attorneys general to withdraw from this case, or urged them to drop it altogether, but they refused to do so.

The medical community has spoken loudly and clearly about the harms this ruling would cause people around the country.

  • American Cancer Society-Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association, and National Multiple Sclerosis Society: “Striking down these provisions would be catastrophic and have dire consequences for many patients with serious illnesses.”
  • American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry: “​Invalidating the guaranteed-issue and community rating provisions — or the ​entire ACA — would have a devastating impact on doctors, patients, and the American health care system as a whole.
  • American Hospital Association, Federation of American Hospitals, the Catholic Health Association of the United States, and Association of American Medical Colleges: A judicial repeal would have severe consequences for America’s hospitals, which would be forced to shoulder the greater uncompensated-care burden that the ACA’s repeal would create.”
  • AARP: Before ACA’s protections, discrimination against those with pre-existing conditions, age rating, and annual and lifetime caps made accessing health care out of reach for older adults.