Washington Wire: March 2019

Protections for people with pre-existing conditions. You may recall that last December, a federal district court ruled in Texas v. United Statesthat the Affordable Care Act is unconstitutional in its entirety. This ruling, if upheld, would:

  • eliminate important protections for people with pre-existing conditions;
  • end the ACA’s Medicaid expansion;
  • abolish the requirement that health plans allow families to keep young people on their parents’ insurance until age 26;
  • repeal protections against uncapped out-of-pocket costs for patients;
  • bring back annual and lifetime limits on coverage;
  • and more.

In the words of one health law expert, overturning the ACA would “wreak havoc” with a law that “is now part of the plumbing of the health care system.” The effects of that disruption would be felt by people with employer-provided insurance as well as those who get coverage from the ACA Exchanges and from Medicaid.
For the time being, it is important to understand that the ACA remains in effectwhile the case is on appeal to the U.S. Fifth Circuit Court of Appeals. The U.S. House of Representatives and the attorneys general of 20 “blue” states are defending the ACA in the appellate proceedings – but the U.S. Department of Justice, which normally defends federal laws against constitutional challenges, is arguing against the law. Last summer, DOJ made news when it largely sided with the anti-ACA plaintiffs and urged the court to invalidate the ACA’s protections for people with pre-existing conditions. On March 25, 2019, the Justice Department unexpectedly went still further, announcing that it now takes the position that the entire ACA should be struck down. A Health Affairs blog post comments that “the DOJ’s decision not to defend the ACA breaks with the Department’s long-standing, bipartisan commitment to defend federal laws if reasonable arguments can be made in their defense. Decisions not to defend federal law are exceedingly rare. It seems even rarer to change the government’s position mid-appeal in such a high-profile lawsuit that risks disrupting the entire health care system and health insurance coverage for millions of Americans.”
HFA together with 25 other national patient groups issued a statement opposing the DOJ’s position in Texas v. United States.The coalition also expressed support for legislation introduced on March 26, 2019, in the House of Representatives that would strengthen and expand health care for all Americans. The “Protecting Pre-Existing Conditions and Making Health Care More Affordable Act,” introduced by Reps. Pallone, Neal, and Scott, would take concrete steps to reduce costs for consumers; ensure quality coverage; support enrollment and outreach efforts in the ACA Exchanges; and eliminate short-term, limited duration plans, which discriminate against people with pre-existing conditions. Passage of these reforms would improve the health care system and break down the barriers to coverage faced by people with chronic conditions.
HFA will continue to update you about the ongoing litigation, and we will continue our efforts to advocate for the affordable, quality coverage that we need, in all the forums available to us, at the state and federal levels.
Quick Hits.

  • More than 30 years ago, President Ronald Regan designated the month of March as Hemophilia Awareness Month to bring awareness and attention to those living with a bleeding disorder. HFA and its member organizations across the country recognize March, now known as Bleeding Disorders Awareness Month, with monthlong education and advocacy efforts. These activities bring public awareness to bleeding disorders and encourage conversations which lead to the development of improved treatment and access to care.
    During March, HFA posted daily educational facts and advocacy tips on its social media channels. More than a dozen of HFA’s member organizations succeeded in getting proclamations and resolutions issued at the state and local level – developing advocacy skills and building relationships in the process. Our compliments and gratitude to all who involved themselves in these efforts!

  • In March 2019, Virginia became the first state in the country to enact legislation protecting patients against accumulator adjusters. Governor Northam signed legislation that requires state-regulated health plans to count manufacturer copay assistance toward patient deductibles. Congratulations to all the advocates who worked for this bill, including Virginia Hemophilia Foundation and the Hemophilia Association of the Capital Area!
  • A federal court overturned the Trump Administration’s approval of Medicaid work and reporting requirements in Arkansas and Kentucky. The court found that these requirements are inconsistent with the core purpose of the Medicaid statute. HFA in coalition with other patient advocacy groups has opposed state applications to impose work and reporting obligations on Medicaid enrollees, and joined in a press statement applauding the court’s ruling in these cases.
  • In a decision published on March 28th, a different federal court overturned the Trump Administration’s rule expanding the availability of association health plans. The rule at issue would have allowed small businesses to form groups for the purpose of offering health coverage, specifically, insurance that wouldn’t have to cover all ACA-mandated benefits. The judge wrote that the Administration’s rule expanding association health plans “is clearly an end-run around the ACA.”
  • HFA staff attended a meeting of the Food and Drug Administration’s Blood Products Advisory Committee (BPAC) on March 20thand 21st. Following a discussion of the state of the Zika epidemic in the U.S. and worldwide, BPAC voted to retain existing rules governing blood donation testing for Zika. BPAC also heard presentations on the current epidemiology of HIV in the U.S.; global developments in blood donor deferral policies pertaining to men who have sex with men; data on HIV incidence and prevalence among blood donors; and a proposal for the use of pathogen reduction technology in connection with platelet donations from men who have sex with men.