Losing ACA protections for pre-existing conditions could increase health disparities

If Affordable Care Act protections for pre-existing condition coverage are no longer available, the coronavirus pandemic would leave many Americans - a disproportionate number of whom are people of color - without health insurance, a new Oregon Health & Science University study indicates.

Published in the Journal of the American Board of Family Medicine, the study's findings reveal a third of the more than 7,500 COVID-19 patients who received care at U.S. community health centers between March and October 2020 did not have a pre-existing condition prior to contracting the novel coronavirus.

People of color made up at a significant portion of the COVID-19 patients studied: 51 percent were non-Hispanic Asian, 36 percent Hispanic, and 28 percent non-Hispanic Black. In comparison, the U.S. Census reports America's 2019 population was about 5.9 percent Asian alone, 18.5 percent Hispanic, and 13.4 percent Black alone.

Because Black, Asian and Hispanic residents experienced higher unemployment than Americans as a whole in 2020, the study notes this "puts them at increased risk for losing employer-sponsored health insurance."

If COVID-19 is considered a pre-existing condition and health insurance coverage of pre-existing conditions is curtailed, the situation would be made worse, and health disparities could increase."

Nathalie Huguet, Ph.D., Study's Lead Author, Assistant Professor of Family Medicine, OHSU School of Medicine

The study comes as the U.S Supreme Court considers another legal challenge to the Affordable Care Act, which is commonly referred to as Obamacare and was signed into law by then-President Barack Obama in 2010. The court heard arguments in the California v. Texas case in November 2020 and is expected to rule sometime in 2021.

On Jan. 28, President Joe Biden signed an executive order that directed federal agencies to re-examine "policies that undermine protections for people with pre-existing conditions, including complications related to COVID-19."

"Our findings highlight that minority patients would be most impacted if the ACA mandate differentiating coverage based on pre-existing conditions was altered or revoked. ... Although the future of the ACA is uncertain, it is clear that ensuring protection for patients with pre-existing conditions is essential to achieving health equity," the study reads.