Medical Societies Ask Court to Protect Key ACA Provisions

Kerry Dooley Young

June 15, 2018

Major physician and medical groups on Thursday filed a brief in a federal court to maintain key provisions of the Affordable Care Act (ACA), including protections for people with preexisting conditions.

The AMA led an amicus brief from physicians' organizations that was filed in the case of Texas vs the United States. Separately, the American Cancer Society Cancer Action Network (ACSCAN) submitted a similar appeal on behalf of disease-fighting organizations. These groups are seeking to defend the ACA from the Texas-led case, even as the US Department of Justice (DOJ) recently took the unusual step of abandoning defense of a provision of an enacted law.

In February, officials from 20 states filed a lawsuit led by Texas that challenges the constitutionality of the 2010 healthcare law, according to a statement from the office of the Texas attorney general. In April, the group filed a motion seeking a preliminary injunction against the law. Its lawsuit contends that Congress rendered the ACA "unconstitutional" because of recent tax legislation that stripped away the financial penalty for failing to comply with the individual mandate in the ACA requiring health insurance coverage, the statement said.

"This lawsuit adds further disruption to an insurance market that has been harmed by premium increases and political battles," Barbara L. McAneny, MD, president of the AMA, said in a statement.

Joining the AMA in its amicus brief were the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry.

For its brief, ACSCAN was joined by the American Diabetes Association, the American Heart Association, the American Lung Association, and the National Multiple Sclerosis Society. In the brief, ACSCAN and fellow medical groups referred to multiple studies that show how often people missed out on medical care for serious conditions before the enactment of the ACA.

"Before the ACA, more than half of heart patients reported difficulty paying for their care, and of those patients, more than 40 percent said they had delayed care or had not filled prescriptions," the groups said in a news release. "Uninsured patients with diabetes were six times as likely to forgo necessary medical care than those with coverage. Uninsured patients were less likely to be screened for cancer and more likely to be diagnosed with later-stage disease, which is harder to survive and more costly to treat."

GOP Rift

US Attorney General Jeff Sessions, a longtime critic of the ACA, said this lawsuit marks "a rare case" in which the executive branch won't fully defend a federal law.

In a June 7 letter to House Speaker Paul Ryan (R-WI), Sessions said the DOJ will decline to defend the constitutionality of a section of the ACA, known as 26 USC 5000(A)a, which pertains to the individual mandate.

"This question of statutory interpretation does not involve the ACA's constitutionality and therefore does not implicate the Department's general practice of defending the constitutionality of federal law," Sessions wrote.

The DOJ's action exposed a rift among Republicans on healthcare policy.

"The Justice Department argument in the Texas case is as far-fetched as any I've ever heard," said Sen. Lamar Alexander (R-TN), the chairman of the Senate's Health, Education, Labor and Pensions Committee, in a June 12 statement.

Alexander said Republicans want to expand insurance options for people with preexisting conditions. He cited as evidence a new Department of Labor rule that he said is intended to make lower-cost employer insurance with patient protections available to the self-employed and more employees of small businesses.

"There's no way Congress is going to repeal protections for people with preexisting conditions who want to buy health insurance," Alexander said. "Congress specifically repealed the individual mandate penalty, but I didn't hear a single senator say that they also thought they were repealing protections for people with preexisting conditions."

Defending Preexisting Conditions

On a conference call with reporters on Wednesday, Kathleen Maloney Skambis, a member of the board of the American Lung Association, said insurers often used to review patients' prior medical histories and bills in order to find a reason to evade paying for care of serious illnesses.

Before the ACA, a past report of an ache or dizzy spell could be construed by insurers as evidence of an undisclosed preexisting condition, said Skambis, who herself survived a battle with lung cancer.

"Then they denied the claim, and often they canceled the policy," Skambis said. "We cannot go back to those times."

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