Oct 18, 2018

ACA lawsuit also threatens protections in employer coverage

Protestors in Miami, Florida. (Photo: Joe Raedle/Getty Images)

Texas' lawsuit over the Affordable Care Act could roll back protections for pre-existing conditions even among people who don't get their coverage through the Affordable Care Act.

Why it matters: These protections are the most popular part of the ACA, and have led to a lot of sick people getting coverage. Millions of people could lose all or part of that security if this lawsuit succeeds.

How it works: Before the ACA, the federal privacy law known as HIPAA prevented employer-based insurance plans from denying employees coverage because of a pre-existing condition or charging those employee a higher premium. The ACA extended similar protections to people who buy insurance on their own.

Yes, but: There's a chance some of the HIPAA protections could go away if Texas' lawsuit succeeds, because of the way the ACA incorporated them, Kaiser Health News reported.

  • "The ACA certainly changed up the HIPAA provisions and it is not clear they would just reemerge," said Gary Claxton of the Kaiser Family Foundation.
  • Even if the HIPAA protections remain in place, people enrolling in employer coverage could face waiting periods for coverage of their pre-existing conditions if the ACA's protections are struck down.
  • HIPAA allowed employer plans to wait up to 12 months to cover pre-existing conditions if a new enrollee hadn't been continuously covered for at least 12 months prior.

Republican attorneys general want the courts to strike down the entire ACA, while the Trump administration says only its protections for pre-existing conditions should fall.

  • If the red states' argument prevails in court, it would eliminate the ACA's cap on how much enrollees pay out-of-pocket and its ban on annual and lifetime limits.
  • For small businesses, the lawsuit would knock down the ACA's ban on charging higher premiums based on health status or gender, and its limits on age variation.

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Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 3 a.m. ET: 1,275,856 — Total deaths: 69,514 — Total recoveries: 262,999Map.
  2. U.S.: Total confirmed cases as of 3 a.m. ET: 337,638 — Total deaths: 9,647 — Total recoveries: 17,582Map.
  3. Federal government latest: Surgeon general says this week will be "our Pearl Harbor, our 9/11 moment." The USDA confirms that a Bronx zoo tiger tested positive for coronavirus.
  4. 2020 latest: "We have no contingency plan," Trump said on the 2020 Republican National Convention. Biden says DNC may have to hold virtual convention.
  5. States updates: New York Gov. Andrew Cuomo said the state is "literally going day-to-day" with supplies.
  6. World update: Queen Elizabeth II urges the British people to confront pandemic with "self-discipline" and "resolve" in rare televised address.
  7. What should I do? Pets, moving and personal health. Answers about the virus from Axios expertsWhat to know about social distancingQ&A: Minimizing your coronavirus risk.
  8. Other resources: CDC on how to avoid the virus, what to do if you get it.

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Data: The Center for Systems Science and Engineering at Johns Hopkins, the CDC and China's Health Ministry. Note: China numbers are for the mainland only and U.S. numbers include repatriated citizens and confirmed plus presumptive cases from the CDC

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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios

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Why it matters: U.S. Surgeon General Jerome Adams said on Sunday this upcoming week will be "the hardest and saddest week of most Americans' lives" — calling it our "our Pearl Harbor, our 9/11 moment."

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