Legal officials from 20 states and the District of Columbia are asking the Supreme Court for a speedy review of the Affordable Care Act decision. Ted Eytan
A 2017 rally in favor of the Affordable Care Act. Ted Eytan

Washington – Nearly one-in-four residents of the Hartford metropolitan area have a pre-existing medical condition that might make it difficult for them to obtain insurance coverage for that illness if a key provision in the Affordable Care Act is overturned, a new study says.

Protections for people with pre-existing medical conditions has become a hot-button issue in the midterm elections as the Trump administration has moved to undo some ACA provisions. A federal court in Texas is set next month to hear a challenge to the ACA.

Since 2014, the Affordable Care Act has prohibited individual market insurers from denying coverage due to a current or past diagnosis of a so-called “declinable medical condition.”

A Kaiser Family Foundation study released this week of people with those conditions in major metropolitan areas determined that 24 percent of the non-elderly residents of the East Hartford-Hartford-West Hartford area have a medical condition that in the past allowed insurers to deny that person coverage.

In an earlier study, Kaiser determined that, nationally, the number of Americans with pre-existing conditions was 27 percent.

The list of pre-existing ailments is long, covering a wide range of medical conditions – from pregnancy and sleep apnea to cancer and heart disease.

While many people with pre-existing conditions obtain health insurance through an employer or through a government-run program like Medicaid, the study suggests that in some areas, many adults would be ineligible for individual market insurance if ACA protections were eliminated and they were to lose their current coverage.

The study found the number of Americans with pre-existing conditions varied widely from metropolitan area to metropolitan area.

In the Worcester, Mass. metro area, which includes part of Connecticut, it was 27 percent. In the Springfield, Mass. metro area it was 26 percent.

The fewest people with pre-existing health conditions — 20 percent — lived in Logan, Utah and the highest, 41 percent, lived in Kingsport, Tenn.

“In some communities in the United States,  more than one-third of non-elderly adults have a pre-existing condition that would lead to a denial of individual insurance without the ACA’s requirements,” said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation.

He said the Trump administration has taken several steps to weaken protections for people who have medical conditions.

It has expanded the availability of short-term insurance plans, which are exempt from ACA-required coverage requirements, including guaranteed access to insurance for people with pre-existing conditions. Connecticut and a handful of other states have passed laws restricting those plans.

Sens. Richard Blumenthal and Chris Murphy introduced legislation this week that would block the expansion of short-term plans. Supported by 30 Democratic senators, the legislation has a slim chance of being considered in the GOP-controlled Senate.

Connecticut also has a law that prohibits insurers from denying coverage to state residents with pre-existing conditions who don’t have short-term plans.

But that protection, as well as the state-mandated “essential health benefits” all insurers in the state must provide, is predicated on the ACA and would be vulnerable to repeal if the health care law no longer existed.

Texas v. United States was filed by officials from 20 “red states,” all won by President Donald Trump in 2016.

The challenge to the ACA argues that since last year’s fedeeral tax overhaul removed the penalty for people without health insurance, the entire health care law is now unconstitutional. The Trump administration decided in June not to defend the ACA against the Texas lawsuit and agreed with the plaintiff states that key provisions of the act are unconstitutional.

Democratic attorneys general from 16 states, including Connecticut and Washington, D.C., are defending the 2010 law.

Because the Texas case may very well end up in the nation’s highest court, Democrats will question Supreme Court nominee Brett Kavanaugh about his position on the constitutionality of the Affordable Care Act and the provision protecting people with pre-existing conditions during confirmation hearings GOP Senate leaders hope to hold next week.

Sen. Chris Murphy argues against repeal of the Affordable Care Act on the Senate floor in 2017. YouTube

“If that case ends up in the Supreme Court, Kavanaugh would be the swing vote in overturning the protections in the law,” Murphy said.

Although the health care law is controversial and support for it in polls seldom reaches 50 percent, a number of surveys show the ACA’s protection of people with pre-existing conditions is popular with voters.

A recent Kaiser Health Tracking poll showed that more than six out of ten (63 percent) respondents said a candidate’s position on continuing protections for people with pre-existing health conditions is either the “single most important factor” or “very important, but not the most important factor” in determining who they would vote for in November’s midterm election.

“It’s one explosive issue. People are freaked out about going back to the old ways (without protections),” said Murphy, a staunch defender of the ACA in Congress.

He called ending protections for pre-existing conditions “really bad policy and really bad politics.”

Sen. Thom Tillis, R-N.C., recently introduced a bill with the support of nine other Senate Republican  called the “Ensuring Coverage for Patients with Pre-Existing Conditions Act” that says no insurer may reject an insurance applicant based on his or her medical condition or history

But the legislation has a loophole. It doesn’t require that the insurer cover the treatment of an applicant’s preexisting condition.

Blocking treatment for certain illnesses in a health insurance policy are called “exclusions.” Tillis’ bill would not eliminate this insurer practice.

Ana has written about politics and policy in Washington, D.C.. for Gannett, Thompson Reuters and UPI. She was a special correspondent for the Miami Herald, and a regular contributor to The New York TImes, Advertising Age and several other publications. She has also worked in broadcast journalism, for CNN and several local NPR stations. She is a graduate of the University of Maryland School of Journalism.

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