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Could COVID-19 become a pre-existing condition if the Supreme Court scuttles Obamacare?

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Late Thursday, the Trump administration doubled down on its stance that the Affordable Care Act (ACA), or Obamacare, should be struck down in its entirety by the Supreme Court. And should SCOTUS heed the logic, it could have significant consequences for Americans in the midst of the coronavirus pandemic, including the possibility that health insurers would be able to consider COVID-19 a pre-existing condition and hike how much patients have to pay.

The administration filed a briefing with the Court asserting that the effective repeal of the ACA’s individual mandate, which requires most Americans to carry a minimal amount of health coverage or face a fine, means that Obamacare in its whole should be struck down.

“No further analysis is necessary; once the individual mandate and the guaranteed-issue and community-rating provisions are invalidated, the remainder of the ACA cannot survive,” wrote solicitor general Noel Francisco, who argues cases on behalf of the government in front of the Supreme Court. 

Presumptive Democratic presidential nominee Joe Biden slammed the administration’s decision as irresponsible as COVID-19 cases and hospitalizations mount across the country.

“Some survivors will experience lasting health impacts—like lung scarring and heart damage,” said Biden on Thursday. “And if Donald Trump prevails in court, insurers would be allowed to strip away coverage or jack up premiums simply because of their battle with the coronavirus.”

The Affordable Care Act is a wide-ranging law that encompasses far more than individual insurance marketplaces where customers can buy subsidized coverage. It mandates that people up to the age of 26 can remain on their parents’ insurance; through Medicaid expansion, the law has extended coverage for tens of millions of low-income people (one study by the Economic Policy Institute suggests close to 30 million people would be stripped of health coverage were the ACA nixed); and, critically, it bars insurers from hiking prices for someone with a pre-existing condition.

That could have outsized effects for COVID-positive patients and beyond.

“If pre-existing conditions were excluded from coverage, nearly all people with these conditions would see increased out-of-pocket costs,” according to the nonpartisan Commonwealth Fund think tank. “Average out-of-pocket costs for those with cancer or diabetes would triple, while costs for arthritis, asthma, and hypertension care would rise by 27 percent to 39 percent. Some individuals would see much larger increases.”

It’s less clear exactly how much insurers would hike up rates for a patient with coronavirus given the novelty of this disease. But since hospitalized patients can rack up big medical bills even under Obamacare, the price tag could very well skyrocket. Uninsured patients have already seen tens of thousands of dollars in COVID-related medical bills in recent months; if the Supreme Court strikes down the Affordable Care Act in its entirety later this year, even insured patients may face exorbitant costs without the health law’s anti-discrimination measures for those with pre-existing conditions.

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