Court Ruling Helps Thom Tillis Rip Away Protections for People with Pre-Existing Conditions

Decision From Federal Judge Means:

Medicaid Expansion is Gone

Protections for Pre-Existing Conditions are Gone

Hundreds of Thousands of North Carolinians Will Lose Health Care

And Thom Tillis OWNS IT

Washington, D.C. –  Last night, conservative U.S. District Judge Reed O’Connor issued his ruling in Texas, et. al. vs. United States, et. al., siding with Republican attorneys general, governors, the Trump Administration, and Senator Thom Tillis  to overturn the entire Affordable Care Act (ACA). Whether it’s repealing the individual mandate to pay for tax cuts or ramming through partisan repeal legislation, repeal cheerleader Thom Tillis has done nothing but support the GOP’s efforts to strip coverage from hundreds of thousands of North Carolinians. Brad Woodhouse, executive director of Protect Our Care issued the following statement:

“Like two sides of the same coin, Thom Tillis and the Trump Administration have worked relentlessly to undermine the Affordable Care Act. Today, they are one step closer to ripping health care away from millions of North Carolinians with pre-existing conditions like cancer, diabetes, or asthma.  If this ruling isn’t overturned, Thom Tillis will roll back the clock and take North Carolinians back to the days where insurance companies had the power to once again deny, drop, or charge more for coverage. They will once again have the power to impose annual or lifetime limits and charge women and seniors more based on their age and gender. Make no mistake, these actions will hurt hundreds of thousands of North Carolinians.”

BACKGROUND:

Due to Judge O’Connor’s ruling yesterday, Republicans are one step closer to repealing the Affordable Care Act and eliminating key protections, unleashing — as the Trump Administration itself admitted in his court — “chaos” in our entire health care system. Under this ruling:

• Marketplace tax credits and coverage for 10 million people: GONE.
• Medicaid expansion currently covering 15 million people: GONE.
• Protections for more than 130 million people with pre-existing conditions when they buy coverage on their own: GONE.
• Allowing children to stay on their parents’ insurance until age 26: GONE.
• Free annual wellness exams: GONE.
• Ban on annual and lifetime limits: GONE.
• Ban on insurance discrimination against women: GONE.
• Contraception with no out-of-pocket costs: GONE.
• Limit on out-of-pocket costs: GONE.
• Requirement that insurance companies cover essential benefits like prescription drugs, maternity care, and hospitalization: GONE.
• Improvements to Medicare, including reduced costs for prescription drugs: GONE.
• Closed Medicare prescription drug donut hole: GONE.
• Rules to hold insurance companies accountable: GONE.
• Small business tax credits: GONE.

What’s at stake for North Carolina:

• The coverage that 552,000 North Carolinians gained through the ACA by 2015.
• Protections for 3,929,400 North Carolinians who have a pre-existing health condition.
• The health care of roughly 70,000 young adults in North Carolina who have coverage because they can stay on their parents coverage until age 26.
• The nearly 3,966,308 North Carolinians, most of whom have employer coverage, who can access free preventive care at no cost.
• The 3,091,000 North Carolinians with employer coverage who no longer have to worry about lifetime or annual limits.
• Seniors’ drug savings — 165,931 North Carolina seniors are saving $185.3 million on drugs in 2017, an average of $1,117 per beneficiary because the ACA closed the Medicare prescription drug donut hole.

Because Judge O’Connor Sided With Republicans, 17.1 Million People Would Lose Their Coverage

• According to the Urban Institute, 17.1 million people would lose coverage in the first year by repealing the Affordable Care Act, leading to a 50 percent increase in the uninsured rate.

Because Judge O’Connor Sided With Republicans, Insurance Companies Could Be Put 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, including 544,000 in North Carolina.
• 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. This includes 803,300 in North Carolina.
• 3,929,400 North Carolinians have a pre-existing condition.

Because Judge O’Connor Sided With Republicans, Insurance Companies Could Have 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. If Judge O’Connor rules in favor of Republicans, insurance companies will be able 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

Because Judge O’Connor Sided With Republicans, Insurance Companies Could Have 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.
• Insurance Companies Could Charge Premium Surcharges in the Six Figures. If Judge O’Connor sides with Republican lawmakers, insurance companies would be able to charge people more because of a pre-existing condition. The health repeal bill the House passed in 2017 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 Could Be Charged More Than Men for the Same Coverage. Prior to the ACA, women 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 Could Face a $4,000 “Age Tax,” Including $5,720 in North Carolina. If Judge O’Connor sides with Republican lawmakers, insurance companies would be able to 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, including $5,720 in North Carolina, according to the AARP.
• Seniors Would Have to Pay More for Prescription Drugs. If Judge O’Connor sides with Republican lawmakers, seniors would 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 CMS report. In North Carolina, 165,931 North Carolina seniors are saving $185.3 million on drugs in 2017, an average of $1,117 per beneficiary

Because Judge O’Connor Sided With Republicans, Insurance Companies Could Have the Power to Limit the Care You Get, Even If You Have Insurance Through Your Employer

• 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.
• Reinstate Lifetime and Annual Limits. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage.
• Large Employers Could Choose to Follow Any State’s Guidance, Enabling Them Put Annual and Lifetime Limits on Their Employees’ Health Care. Without the ACA’s definition of essential health benefits (EHB) in even some states, states could eliminate them altogether. Large employers could choose to apply any state’s standard, making state regulations essentially meaningless. Because the prohibition on annual and lifetime limits only applies to essential health benefits, this change would allow employers to reinstate annual and lifetime limits on their employees’ coverage.