The rash of hearings on pre-existing conditions that began last week spilled over into this week with the House holding three separate hearings on Wednesday on the potential impact of the ACA’s pre-existing conditions being overturned. These hearings are coming to the fore as the federal lawsuit in Texas v. U.S. makes its way through the courts, after a federal court ruled last December that the entire ACA was unconstitutional, including protections for pre-existing conditions, on the basis of the individual mandate effectively no longer serves its role with penalties reduced to zero. This week, the Trump Administration and Democratic attorneys general filed paperwork requesting oral arguments to begin in July for the appeal to the Texas decision.
The House Energy and Commerce Health Subcommittee held a broad hearing on the implications to the entire healthcare system, both public and private, should the Texas decision be upheld. As expected, Democrats at the hearing criticized the Trump administration and Congressional Republicans for targeting the coverage of pre-existing conditions through the lawsuit and other steps the administration took to weaken those protections, such as expanding insurance plans that do not comply with the law. After prompting from Republicans to pass legislation in response to the lawsuit, Chairwoman Anna Eshoo (D-CA) indicated the panel will hold a hearing to consider bills that would reverse the administration's expansion of short-term plans, restore funding that was cut for outreach and enrollment efforts on the law, and reverse the administration’s guidance for states to use waivers to change their insurance markets. Despite the partisan wrangling among the committee members, there was overall agreement on the potential for implementing a reinsurance system.The House Committee on Education and Labor held a similar hearing, “Examining Threats to Workers with Preexisting Conditions” to hear from industry representatives and individuals with pre-existing conditions. Members of the committee discussed the role pre-existing conditions have in preventing patients from receiving adequate and affordable healthcare, and the potential impact of the Texas ruling on insurance, including employer-based coverage. Several witnesses suggested the lawsuit could work to eliminate protections for patients resulting in annual and lifetime coverage caps, out-of-pocket expenses, and delayed preventative care. Several Republican members emphasized their desire to repeal and replace the ACA with more functional legislation. However, these efforts ultimately failed in the last session of Congress when Republicans controlled both houses of Congress and only narrowly passed a limited-scope repeal through the House that was repeatedly rejected by the Republican-led Senate.
The House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies held their hearing focused on the Trump Administration’s policies on the ACA as they relate to affordability, the increasing number of uninsured people, and the quality of benefits provided. The committee also discussed recent efforts by the administration to shift consumers towards short-term insurance plans and expressed support for strengthening protections for patients with pre-existing conditions. Overall, the witnesses expressed support for outreach and advertising as the primary drivers of increasing insurance enrollment rates and encouraged CMS to publish the data on advertising and rates of enrollment.