A Texas lawsuit has put the ACA’s popular pre-existing conditions provision front and center ahead of midterms, to the chagrin of Republicans who have vehemently opposed the law for years.
“Everyone agrees we’re going to protect pre-existing conditions,” Senator Ted Cruz said in a debate this month. Yes, the same Ted Cruz who forced a federal government shutdown in 2013 to try to defund the Affordable Care Act, including pre-existing condition protections. The same Ted Cruz who has introduced measures weakening those protections and voiced support for a Texas lawsuit to eliminate them.
“I have never been for ending pre-existing conditions,” said Congressman Pete Sessions in September. On his website, Sessions boasts that he has “voted more than 60 times to repeal, dismantle, and defund” the ACA, which ensures that people with pre-existing medical conditions can’t be denied coverage or charged more — one of the law’s most central and popular provisions.
“All Republicans support people with pre-existing conditions, and if they don’t, they will after I speak to them,” President Donald Trump tweeted earlier this month. “Republicans will totally protect people with Pre-Existing Conditions, Democrats will not!” he added last week. But Trump’s administration is currently suing to overturn these protections in court and just last week issued guidance that makes it easier for states to opt out of coverage requirements.
Republicans in Texas and around the country are trying to lie their way out of a problem: The ACA’s pre-existing condition protections are extremely popular and remain a dominant campaign issue with one week to go before the midterm elections. But many Republicans now in competitive races have spent years fighting these protections as part of their vendetta against the federal health care law and President Barack Obama. Now, they’re trying to erase that history — even going so far as to claim to be the crusaders for these protections, while actively suing over or railing against the law that created them.
The conflict is particularly potent in Texas, where Attorney General Ken Paxton is leading a lawsuit to overturn the entire ACA, including pre-existing condition protections. The suit, filed by Paxton and 19 other Republican attorneys general in February, has been called “absurd” and “far-fetched” by attorneys and lawmakers on both sides of the aisle.
The issue came to a head this spring when Trump’s Department of Justice sided with Texas in declaring pre-existing condition protections unconstitutional and declining to defend the law. If Team Trump is successful, the consequences would be huge. Texas already has the highest uninsured rate in the country, and about 4.5 million Texans have a condition that could make them uninsurable without the ACA’s protections.
As a result, Republicans in races across the state are trying to wipe away their records with seemingly empty promises. Houston Republican John Culberson has staunchly opposed the ACA but said in his campaign that he also supports pre-existing condition protections. He quietly deleted mention of the ACA from his website, where he previously boasted about his many repeal votes, according to ThinkProgress.
Governor Greg Abbott said in the gubernatorial debate last month that “Under no circumstances will [Texans] lose coverage for pre-existing conditions, period,” even though he has called for full repeal of the ACA. Congress “has already made clear” the protections will continue, and “I, as governor, will work to make sure pre-existing conditions in Texas are covered,” he said, without offering any specifics. Abbott’s office did not respond to a request for comment.
There’s a big difference between supporting these requirements in theory — if these Republicans in fact do — and supporting them in practice. GOP candidates claiming they’ll protect patients with these conditions have rarely proposed alternate policies that would do so. For the most part, they speak vaguely of repealing the ACA in favor of more “flexibility” and “state sovereignty.”
But Texas’ pre-ACA marketplace allowed insurers to charge people more based on health, gender or age, as well as to routinely refuse coverage for certain patients or conditions. The only option for people with pre-existing conditions was to join the separate high-risk pool, which, with premiums twice as high as the regular market, was unaffordable to most Texans.
Asked how Cruz plans to protect patients with pre-existing conditions and how he squares this alleged support with his votes against the ACA, his office replied with a statement that didn’t mention pre-existing conditions or an alternative to the ACA. “Texans want more healthcare freedom and choice, not skyrocketing premiums, narrowing networks, and a one-size-fits-all approach to healthcare determined by Washington bureaucrats,” a spokesperson wrote.
In response to Observer questions, Sessions, noting that his son has Down syndrome, pointed to a nonbinding resolution he introduced in September saying that any health care plan should preserve pre-existing condition protections. Sessions also pointed to his bill introduced in 2016 and 2017, dubbed the “World’s Greatest Healthcare Plan,” which would preserve some protections for patients with pre-existing conditions, but eliminate the ACA’s individual and employer insurance mandates. It didn’t get a vote.
“Americans deserve a healthcare system where they have choices in insurance, where vulnerable patients are protected, and where tax credits help Americans afford coverage,” Sessions wrote in an email. That system, he said, is definitely not the ACA’s “one-size fits all mandate,” or Medicare for All. “States should have the latitude to tailor their healthcare system to achieve these ends.” Asked if he supports Paxton’s lawsuit, Sessions didn’t respond.
Paxton, for his part, is “pleased” the Trump administration agreed that major parts of the ACA should be struck down, a spokesperson previously told the Observer. He didn’t respond to questions about people potentially losing coverage, or ideas for any kind of replacement. But he hasn’t indicated he’s interested in keeping these kinds of protections at all.