Mainers with pre-existing medical conditions are worried they will lose health insurance under the Trump administration's latest attempt to unravel the Affordable Care Act (ACA). Consumers, providers and health advocates shared their concerns with independent Sen. Angus King at a roundtable discussion in South Portland Monday. And it's not only those who buy insurance on the online marketplace who would be affected if protections for pre-existing conditions are repealed.
Earlier this month, the Trump administration filed a legal brief announcing it would not defend a provision of the Affordable Care Act that requires insurers to provide coverage to people with pre-existing conditions. Some consumers who would be affected by the new policy told Sen. King that they are fearful and angry.
"I'm offended to my core that my daughter is even thought of in some circles as a pre-existing condition. She's not,” says Patty Morris.
Morris, of Cape Elizabeth, has a 30-year-old daughter with cystic fibrosis.
"She's my daughter, Ally,” Morris says. “She's a hard worker, pays taxes, and she works full time on top of that, controlling the symptoms of her cystic fibrosis."
Morris says her daughter's medication costs more than $250,000 per year. Without insurance, she says, she would go bankrupt trying to help her daughter pay for it.
Linda Homer of Southwest Harbor says her family would also go bankrupt if she lost insurance coverage. She and her three kids have a genetic predisposition for a rare kidney cancer.
"You have to be checked at least yearly because by the time symptoms occur, it's too late, it's too aggressive,” says Homer. “So we require an MRI, ultrasound, CAT scan."
Texas and 19 other states are challenging the ACA's protections for people with pre-existing conditions, calling them unconstitutional. The basis for their argument stems from the tax bill passed by Congress late last year, which repealed the individual mandate penalty. The mandate is still there but there are no teeth to enforce it. Repeal of the penalty, the lawsuit asserts, makes the individual mandate, and guaranteed coverage for pre-existing conditions, unconstitutional.
In its legal brief in response, the Department of Justice agreed that such protections should be invalid.
"The ACA is not collapsing. It's being mugged. That's what's happening piece by piece. And this pre-existing conditions is just another piece,” says Sen. King.
King called the Trump administration's move a “perverse policy” that discourages preventive care.
The president of Mercy Hospital in Portland, Charlie Therrien, says it's also a policy that will raise health care costs for everyone.
"Every time we whittle away at a lot of the components of the ACA, it's ultimately just going to push people away from having insurance,” Therrien says. “And when you push people away from having insurance, it's either no insurance at all or high premiums with high deductibles and high out of pocket expense, people are going to avoid health care, and when they avoid health care, they're going to get sicker.”
And when the uninsured or under-insured do finally seek care at hospitals, Therrien says there's a consequence.
"The cost of that ultimately gets pushed back through higher premiums for everybody else," Therrien says.
And if the lawsuit is successful, it's not just people with pre-existing conditions who purchase insurance on the ACA marketplace who could lose coverage, says Kate Ende of Consumers for Affordable Health Care.
"You know, a lot of times we forget that the marketplace is just one piece of the ACA, and so these protections are far-reaching,” Ende says. “And so people in individual plans off-marketplace, and even some group plans would see the impact of this.”
That means some consumers with pre-existing conditions who have employer-based insurance could lose coverage, despite the fact that Maine has a 25-year-old state law that requires insurance companies to offer plans to consumers regardless of health status.
Ende says it was groundbreaking at the time, but there were loopholes.
"The Affordable Care Act protections are so much broader and more comprehensive,” Ende says. “So for example, in Maine, if you had potentially gone without coverage for a certain period of time, then that pre-existing condition might be able to be excluded."
Sen. King pledged to share the insights and stories of his Maine constituents with other lawmakers to urge them to preserve the ACA's protections for pre-existing conditions. Meanwhile, a bipartisan group of governors issued a joint statement on Monday condemning the Trump administration's policy.
