The start of the 116th Congress ushered in a new political dynamic between the two chambers of the U.S. Congress. With the Democrats now in control of the House of Representatives, one of the main priorities of the majority party has focused on retaining the popular components of the Affordable Care Act (ACA). To reinforce the importance of this issue, key committees already have convened hearings on a variety of topics related to protecting of paramount ACA provisions.
Protections for patients with preexisting conditions
The House Ways and Means Committee started off its committee business with a hearing January 29 focused on protecting coverage for people with preexisting conditions. While Democrats argued that it is essential to maintain these protections, Republicans stated that they have continued to support the protection of patients with preexisting conditions. Indeed, safeguarding coverage for patients with preexisting health care conditions was one of the most popular provisions of the law and as such has become a key part of recent political messaging. Both the House Energy and Commerce and Education and Labor Committees also held hearings in February during which preexisting condition protections were a primary focus.
On the Senate side, the Senate Health, Education, Labor and Pensions (HELP) Committee convened hearings on the issue in the 115th Congress, but it has yet to hold hearings on preexisting conditions this year. The American College of Surgeons (ACS) supports protections for patients with preexisting conditions and will continue to follow any changes closely.
Consumer protections within a weakened ACA
Over the last two years, the Trump Administration has sought to weaken the ACA, including President Trump’s issuance of an Executive Order to loosen rules regarding short-term, limited-duration insurance plans. These plans tend to be less comprehensive and have higher deductibles, and many Democrats fear that consumers may not fully understand the fine print of the health plans. During an Energy and Commerce hearing, members of Congress discussed various proposals to either reverse the President’s Executive Order or to require that these insurance policies come with a warning to consumers.
Constitutionality of the ACA
Another Energy and Commerce Committee hearing focused on the lawsuit Texas versus The United States of America. In February 2018, 20 Republican Attorneys General and Governors filed suit challenging the constitutionality of the ACA’s individual mandate and the law in its entirety. In December 2018, the District Court for the Northern District of Texas struck down the ACA in its entirety. The federal district court ruled that because the mandate penalty was set at zero, it is no longer valid as a tax and is therefore unconstitutional. The district court further concluded that the individual mandate was “essential” to the remainder of the ACA and declared the entire law invalid. The district court issued a stay and partial final judgement, allowing the case to be appealed to the Fifth Circuit Court of Appeals. The law remains in effect while the case is being appealed.
If the district court ruling stands on appeal, every provision of the ACA will be overturned, including protections for preexisting conditions, the ACA marketplaces and affordability subsidies, Medicaid expansion, and the closing of the Medicare prescription drug “donut hole.” Additionally, it would eliminate prohibitions on annual or lifetime dollar limits on coverage, guaranteed issue and renewability, comprehensive essential health benefits coverage, and limits on out-of-pocket spending. It also would end the popular provisions that extend coverage of preventive services without cost-sharing and coverage for dependents up to age 26. On January 9, 2019, under the leadership of Speaker Nancy Pelosi (D-CA), the House of Representatives voted on H. Res. 6, which allows Congress to intervene in the case and defend the ACA.
The College’s stance
Regardless of the politics surrounding the debate on the ACA, the ACS believes that ongoing health reform efforts will require market stabilization for the health insurance industry. It is essential that health care coverage be accessible and more affordable to all Americans. As Congress looks to improve the health care system, it is imperative that any reforms retain the gains made in insurance coverage and protections for patients with preexisting conditions, particularly for at-risk populations. The ACS also maintains that the Essential Health Benefits (EHBs) mandated under the ACA is critical to protecting access to surgical care. Through the process of market stabilization and improvement of the law, Congress must not limit services and compromise the safety net these patients rely upon.
The topic of protecting the ACA is unlikely to disappear from the forefront of congressional debate, as many of the law’s protections have been popular with many Americans. As the 116th Congress continues, the College remains committed to working with congressional leaders to improve patient access to surgical care.
For more information on congressional action regarding the ACA, contact Carrie Zlatos, ACS Senior Congressional Lobbyist, at czlatos@facs.org or 202-672-1508.
