Shine Maddox has racked up $160,000 in charges for biopsies,
chemotherapy, medications and scans since being diagnosed with
breast cancer in February. Now the 55-year-old Mt. Airy
resident looks forward to finishing treatment and being able
to call herself a cancer survivor.
then, she’ll be among the one-fourth of Americans under age
65 who could be uninsurable on the individual market at any
price, should the latest effort to water down federal
insurance protections prevail. People insured through
Affordable Care Act marketplaces, rather than a large
employer, may be most nervous about a lawsuit brought by 20
Republican attorneys general that would let insurers return to
the days when they could just say no to people like Maddox.
doing away with that protection could affect even more
Americans. On top of people who couldn’t buy insurance at
all, there also are those with a preexisting condition judged
just severe enough to warrant much higher premiums. Anyone
with a history of depression, an old smoking habit, or a
chronic condition like diabetes could be at a serious
disadvantage in paying for health care, should they lose
large-employer coverage because they want to go to work for a
small company, lose their job, or just want or need to retire
before hitting Medicare age at 65.
kind of all have something, and if we don’t have something
today, chances are by next month we will," said Karen
Pollitz, a senior researcher at Kaiser Family Foundation.
Texas-based lawsuit stems from another way the ACA has been
weakened since the Obama administration. Congress decided to
stop penalizing people who don’t buy health insurance
beginning in January 2019. That vote did away with a mandate
that was unpopular, but that meant insurers could make enough
money on healthy people to afford covering the unhealthy ones.
the Supreme Court ruled that the Affordable Care Act was legal
because it was not forcing people to buy insurance. Rather, it
was charging a tax to anyone who didn’t, which government is
allowed to do. The lawsuit argues that if Congress won’t
enforce the tax, the so-called individual mandate is
unconstitutional and the whole law should go.
Justice Department is partly supporting the suit, specifically
the portion opposing required coverage for those with
lawsuit may be a longshot, legal analysts said. But it
reflects a serious threat to something that once had
bipartisan support — making health care more accessible to
people who need it most. And if it, or a future such effort,
succeeds, it could also spell the end of ACA features such as
required coverage for mental health care and drug treatment,
as well as income-based premium subsidies.
no margin for error," said Sen. Bob Casey, D-Pa., in an
interview with the Philadelphia Inquirer. "We have to
assume the worst and assume this case could have the kind of
far-reaching impact many have argued."
used to be able to use your medical history to decide if you
could buy an individual policy, and what it would cost.
Twenty-seven percent have a history of a condition, such as
cancer, that would have been grounds for flat-out denial in
the individual insurance market, according to the Kaiser
Family Foundation. Others with more benign ailments, such as
acne, faced higher rates.
required insurers to charge everyone roughly the same price,
with adjustments for age and geography.
lawsuit succeeds, the chasm between sick and healthy would
winners and losers," said Mark Pauly, a health economist
at the Wharton School at the University of Pennsylvania.
Healthy people could see their insurance rates go down, while
sick people could be charged more. The immediate impact would
be on people with ACA policies, he noted, while most Americans
have insurance through employers, Medicare or Medicaid.
a tiny segment of the population that’s directly affected,
but they’re going to be really woefully mistreated,"
WON’T COVER YOU AT ANY PRICE’
Deutsch remembers what it was like to be part of that group.
years, Deutsch held onto a health plan she couldn’t afford,
because she couldn’t find another that would cover the Type
1 diabetes she’s had since infancy.
looked everywhere for coverage, contacted everyone I knew who
was out there," said Deutsch, 50, of Narberth. "The
answer came back, ‘No, you’re Type 1 diabetic — we won’t
cover you at any price.’ "
the ACA, her insurance is $650 a month, a price that reflects
a tax subsidy and is half the cost of her old plan. Deutsch, a
pet store owner and the mayor of Narberth, worries about how
she will pay for her medications and supplies without it.
feels like they’re making us choose between bankruptcy or
death," she said.
people insured through large employers, which must follow
equal-coverage rules that predate the ACA, are not immune to
the Texas lawsuit’s outcome. Before the ACA, people who lost
their job, or just wanted to change jobs, often couldn’t get
that concept of freedom and access to coverage — no matter
who you work for or where you are — that is under
fire," said Pennsylvania Insurance Commissioner Jessica
Leavens, 25, who also has Type 1 diabetes, health insurance
would be a major factor in planning her future. She works at
an Allentown life insurance company where she pays hardly
anything for the pump, glucose monitor and other vital
supplies that cost her hundreds of dollars under her father’s
insurance plan, she said.
I were to change jobs at any point in my career, it would
hinge on the benefits the employer was able to offer me,"
the Berks County woman said.
insurance Shine Maddox has through the Pennsylvania Senate,
where she works for Vincent Hughes, offers good coverage for
her cancer treatment.
her cancer made her too sick to work, she could be on her own
to pay for her care.
savings, I know, is not enough to cover that," she said.
"I really don’t know what I would do."
resolution to the lawsuit won’t be swift, as any decision by
the Texas district judge will be followed by a series of
appeals, possibly all the way to the Supreme Court. Sixteen
Democratic attorneys general, including New Jersey’s Gurbir
S. Grewal, have challenged the suit.
meantime, economists expect the suit to make a turbulent
insurance market even more uncertain.
increases are already on the horizon, as insurers grapple with
the likelihood of an overall sicker membership as healthy
people drop out.
unclear how the Trump administration will handle the open
enrollment period for the insurance marketplaces, which
already have lost participation from spooked insurers.
system’s fragility is a source of constant anxiety for those
who rely on it most.
like walking on a tightwire," Deutsch said. "You
feel like one false move and it all comes crashing down."