Medical Groups Urge DOJ to Defend Key ACA Provisions

Move to Drop Pre-existing Conditions Coverage Threatens Vulnerable Patients

June 13, 2018 12:54 pm News Staff – The AAFP and five other medical organizations are urging the Department of Justice to reconsider its decision to not defend key elements of the Patient Protection and Affordable Care Act (ACA) in court.

"Our organizations disagree with the Department of Justice's decision not to defend the protections established by the ACA that prohibit insurance companies from denying or discontinuing coverage for individuals with pre-existing conditions or other factors such as gender or race," reads the statement.(1 page PDF) It was signed by the AAFP, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association, and the American Psychiatric Association, which together have more than 560,000 members.

The groups' statement responds to a federal court brief filed June 7 by the Department of Justice as part of a lawsuit, brought in February by Texas and 19 other states, that asks a district court in Texas to rule the ACA unconstitutional. Texas et al. v. United States et al., unlike previous challenges to the ACA, centers on 2017's Tax Cuts and Jobs Act and its provision zeroing out the penalty associated with the individual mandate to have health insurance.

The current case argues that the U.S. Supreme Court in National Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services et al. in 2012 "interpreted the mandate to be part-and-parcel of a tax penalty" and, therefore, constitutional under Congress' powers of taxation. Once that tax penalty was removed, however, the mandate no longer had any constitutional basis, the plaintiffs argue, rendering the entire statute unconstitutional, including its provisions guaranteeing coverage for all regardless of race, gender or the presence of pre-existing conditions.

Legal defense of the ACA falls to U.S. Attorney General Jeff Sessions, but his office indicated it will defend neither the individual mandate nor the ACA's protection for those with pre-existing medical conditions.

Sessions, in a June 7 letter to congressional leaders, said this was "a rare case where the proper course is to forgo defense" because the administration has concluded the statute is unconstitutional.

But the medical organizations pointed out the urgency of maintaining the ACA's protections.

"As physicians who provide a majority of care to individuals for physical and mental conditions, we can speak clearly that these insurance reforms and protections are essential to ensuring that the more than 130 million Americans -- especially the more than 31 million individuals between the ages of 55 and 64 -- who have at least one pre-existing condition are able to secure affordable health care coverage."

The organizations urged the government to join them in seeking "policy solutions that increase access to affordable health care that provides all individuals, regardless of their gender, race and health status, reasonable protections against discrimination in coverage and pricing."