Trump’s Lethal Shell Game: Will Pre-Existing Conditions Coverage Vanish?

Illustration by Mark WeberIllustration by Mark Weber

Amid all the media attention given to the controversy surrounding the Mueller Report, a critical piece of disability news was nearly crowded out: A March 25 Department of Justice letter sent to the U.S. Court of Appeals for the Fifth Circuit confirmed the DOJ’s support of striking down the entirety of the Affordable Care Act. The letter stated bluntly: “The Department of Justice has determined that the district court’s judgment should be affirmed.”

The letter followed previous statements by President Trump that the ACA’s guaranteed coverage of pre-existing conditions was “safe” and “in no danger.” But if the ruling is eventually upheld by a majority-conservative Supreme Court that now includes two Trump appointees, guaranteed affordable coverage of pre-existing conditions would vanish.

Where would that leave those of us whose chronic disabilities demand continuous, consistent and timely health care coverage?

The National Council on Independent Living issued a fact sheet in January 2017 listing the harmful effects that repealing the Act would likely cause for those who have pre-existing conditions. Here is a general summary of the potential harmful effects as published in the NCIL’s Advocacy Monitor:

• People with disabilities may lose coverage due to pre-existing conditions.

• People with disabilities may lose coverage due to plans being unaffordable.

• People with disabilities may lose their ability to live in their homes and communities.

• People with disabilities may lose Medicaid coverage.

• Unemployment of people with disabilities may increase.

What few people are talking about, however, is the worst possible scenario: People with severe disabilities whose lives often depend on certain medications or treatments that must be administered regularly, often daily, could die.

It is no stretch to predict that thousands could lose their lives. A Jan. 23, 2017 Chicago Tribune article written by two public health experts from different universities claimed that nearly 44,000 lives would be lost as a result of repealing the Act. Similar claims by others who conducted statistical studies were published at about the same time. More recently, an Oct. 28, 2018 Los Angeles Times article pointed out that Trump bragged about supporting legislation to combat the opioid crisis at the same time his administration was pushing hard to eliminate healthcare coverage for those with pre-existing conditions, which “would effectively allow insurers to once again deny coverage to people seeking addiction treatment.” The predictable result? More preventable deaths.

Will the ACA Be Repealed?

It is undeniable that repealing the ACA is one of the Trump administration’s top priorities, as Republicans have been relentlessly pursuing that goal since it became law nine years ago. There have been at least 70 Republican-led attempts to repeal, modify or otherwise curb the Affordable Care Act since its inception (Newsweek, July 29, 2017).

On Jan. 20, 2017, in his first day in office, President Trump signed an executive order to scale back as much of the ACA as possible without congressional action, a move that then-Press Secretary Sean Spicer said, “would ease the burden of Obamacare as we transition from repeal and replace.”

Trump has promised to replace the ACA with an even better plan, but after two years in office neither he nor his party has yet to deliver. His four-pronged attack on the ACA has included campaigning against it, issuing executive orders to weaken or gut it, promoting legislation to repeal it, and his latest — refusing to defend it in front of the Supreme Court.

A relatively recent timeline shows the Trump administration’s actions:

2015-16: Trump promises to abolish the ACA.

2017: Trump-supported congressional attempt to gut the ACA fails.

2018: Texas Attorney General Ken Paxton, a Republican, brings a lawsuit to declare ACA unconstitutional. The lawsuit is joined by 17 other Republican state attorney generals and two Republican governors.

December 2018: Judge Reed O’Connor rules the ACA unconstitutional. O’Connor presides from the conservative United States District Court for the Northern District of Texas, often the court-of-choice for right-wing activists seeking to overturn laws they disagree with, such as the Americans with Disabilities Act and the ACA, as noted by the Dec. 19 Texas Tribune article, “By gutting Obamacare, Judge Reed O’Connor handed Texas a win. It wasn’t the first time.”

Late 2018 through early 2019: Trump falsely claims his administration will protect pre-existing conditions, most notably during his Feb. 5 State of the Union Address.

March 2019: The Trump administration directed the DOJ to send a letter to the Appeals Court in support of O’Connor’s ruling. According to a March 26 Politico article, both Attorney General William Barr and Health and Human Services Secretary Alex Azar opposed this letter.

April 2019: Following House Democrats’ introduction of a bill to protect pre-existing conditions, Senate Republicans counter with a deliberately misnamed PROTECT Act. An April 12 LA Times editorial states: “All the PROTECT Act would do is encourage insurers to do something they did before the ACA: offer cheaper policies with thin coverage aimed at healthy customers, and considerably more expensive policies with comprehensive coverage for people who might actually need costly care.”

May 1, 2019: The DOJ officially files a brief with the Fifth District Court of Appeals in support of declaring the ACA unconstitutional.

Trump’s actions make his intentions clear despite his history of misleading and false statements, which have been publicly documented. His litany of hollow promises, incessant misdirection and ordering government agencies to do the opposite of what he publicly claims he supports are akin to a high-stakes shell game. But it is not a game at all. It is a lethal form of fraudulent misrepresentation.

Trump’s Priorities

A 2017 report published by the Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation states that up to 133 million people under the age of 65 in the United States have some form of pre-existing condition. This is the demographic within which people with chronic severe disabilities due to injury or disease are most likely to be found.

With these huge numbers, it is hard to understand why the Trump administration so aggressively pursues a national health care policy that would alienate all those voters. But he has not ever demonstrated a willingness to enact or support policies that are important to people with disabilities.

Even while running for president, his 2015-16 campaign’s disability policy was notable for being simple and to the point: There was none.

Since his election, his administration has attempted to gut the Special Olympics as well as other programs benefitting people with disabilities, supported legislation to weaken the Americans with Disabilities Act and turned the DOJ from being the enforcer of the ADA to being its nemesis by nullifying rules and regulations and ignoring the need to issue guidelines, and more.

By his actions it is clear Trump does not consider the disability community’s welfare as a viable concern of his or the nation’s.

What Can Be Done to Save Our Health Care Coverage?

After Trump’s election, many who did not vote for him decided to give him a chance, to see what kind of leader he would be. I, for one, held out the hope that the office would shape the man, as it often has throughout the history of our nation. Now we are well past the halfway mark of his four-year term. He has shown, again and again, that he is clearly not a friend of the disability community. It is critically important that people with disabilities, and others with pre-existing conditions, vigorously oppose his plan to abolish the ACA as a well-organized voting bloc — no matter what our party affiliation may be.

Not only is our quality of life at stake, our very lives are in danger.

** This post was originally published on

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