"Everybody I
know in the Senate - everybody - is in favor of maintaining coverage
for pre-existing conditions," Senate Majority Leader Mitch
McConnell said in June. "All Republicans support people with
pre-existing conditions, and if they don't, they will after I speak to them. I
am in total support," President Donald Trump tweeted in October.
This was during the
midterm election campaign, when the Republicans were pedaling
backward to convince America they had no intention of taking away the
protections of the Affordable Care Act. Ignore the efforts
in Congress to repeal the law, they told voters; don't worry about
the Justice Department joining a legal challenge to ACA, asking to strike
down coverage of people with preexisting conditions at no extra cost.
The assurances were
worthless. A court has not only thrown out protections for pre-existing
conditions; it has ruled the ACA as a whole unconstitutional - including the
Medicaid expansion, the requirement that large employers offer health-insurance
benefits, the subsidies for low-income buyers of insurance on the health
exchanges, even the exchanges themselves. All because last
year Congress zeroed out the tax penalty for failing to buy health
insurance - the so-called individual mandate.
For the moment, nothing
will change. The ACA will stand while appeals are filed, probably until the
case reaches the Supreme Court. The new ruling may well be overthrown, but
those who depend on the ACA are left stranded in uncertainty. The timing could
hardly be worse. Enrollment in individual insurance is already down this year,
and the population of uninsured Americans stands to rise.
It's maddening that
the ACA's legal troubles could be easily resolved. Congress needs only to
restore the individual mandate's tax penalties. Keep in mind, the mandate still
exists: Americans are still required to have health insurance.
All Congress did last year was set the penalty for failing to comply
at zero.
Lawmakers could
just as easily restore it. Waiting and hoping for higher courts to overturn the
new ruling risks throwing the U.S. health-insurance system into
chaos. Congress needs to put the ACA back on firm legal ground.
Democrats in
the new House of Representatives will doubtless be willing to act. If
McConnell and Trump were telling the truth during the campaign about protecting
people with preexisting conditions, they won't hesitate to help fix this
problem.
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