A new administration, yet the same question remains: Will the ACA cover Covid as a pre-existing condition? The question has yet to be answered, even though the Supreme Court indicated in November that the Affordable Care Act is constitutional.

For the nation’s eight million-plus people who have contracted Covid-19 and are already considered to have a pre-existing condition due to the virus, losing that designation could lead to lost coverage, particularly for any long-term conditions the virus caused.

How many people stand to be upended by such a change is difficult to determine. A recent Commonwealth Fund study estimated that each day in this country, 20,000 people between 20 and 60 years old likely join this ever-expanding group.

This 20,000 per day figure does not include those people who contracted the virus but showed no symptoms.

Nor does it include those people who had pre-existing conditions before the pandemic struck. It’s a large group : more than 130 million under age 65.

An estimated 40% of people who have had Covid do not realize it, yet the virus has shown it can leave signs. One report from March 2020 described the lung damage in more than half of the computed tomography scans taken of Covid-positive people, together on a cruise ship, who had no symptoms. Called ground-glass opacities, these injuries resemble frosted glass: hazy, but opaque.

A study in late 2020 reported that these injuries could eventually lead to heart and lung problems.

This week, the Biden administration told the high court that it supports keeping the ACA as written.

Background

As Covid-19 continues to bear down on the US, the definition of what constitutes a pre-existing condition has assumed more importance. The pre-existing condition debate erupted in 2017, when Congress approved the Trump Administration’s tax bill. That bill stripped away the individual mandate of the Affordable Care Act – the language that required most US citizens to have health insurance.

The mandate was an effort to drive down prices in the marketplace by merging healthy people with those with pre-existing conditions. For the first time, those in the latter group had coverage, no longer denied coverage on individual healthcare policies.

However, with that mandate gone and the Supreme Court set to determine the ACA’s constitutionality – likely late spring – it’s possible that the pre-existing condition provision could be jettisoned.

Such a move could be disastrous for anyone shopping for health insurance in the middle of a pandemic.

A long list

Eric Schneider, MD, MSc, senior vice president for Policy and Research at The Commonwealth Fund in New York, told MedicalDaily that consumers looking for coverage in the individual insurance market might not find it. “If we return to the pre-ACA world of people filling out health history forms, they will surely include a question about whether someone had previous Covid infection,” said Dr. Schneider. “It might even ask whether someone had a test or worked in an occupation associated with Covid risk. Answering yes to any of those questions could disqualify people from any coverage or exclude coverage for Covid-related conditions.”

Those exclusions could make for a long list. According to Mayo Clinic data, Covid-19 can cause organ damage, specifically to the:

  • heart: damage could lead to increased risk of heart failure
  • lungs: scar tissue could result in long-term breathing difficulties
  • brain: Covid-19 can cause strokes, seizures, Guillain-Barre syndrome, and can increase a patient’s risk of developing Alzheimer’s disease or Parkinson’s disease

Other lingering health concerns include:

  • clotting and blood vessel blockages that could impact lungs legs, liver and kidneys
  • anxiety, post-traumatic stress disorder, and depression stemming from the experience of being treated in intensive care units and being on a ventilator
  • milder Covid-19 symptoms that linger beyond recovery

“Conceivably any future disease involving those organs could be excluded from coverage after a person has a Covid-19 infection,” said Dr. Schneider.

Healthcare holding pattern

Experts are falling just short of being optimistic regarding the fate of the pre-existing condition provision.

“I have seen some insurers release statements regarding continuing coverage regardless of COVID-19, but many are likely waiting for the outcome from the Supreme Court and subsequent legislation,” said Jeremy Belanger, health care attorney with Dickinson Wright in Troy, Mich. Still, Mr. Belanger thinks the move may not be one that insurers are ready to make. “The marketplace is different from where it was prior to the ACA, and many insurers recognize that.”

Eric Gascho agrees. “We are in such a different place than we were a decade ago because of the ACA being in place as long as it has,” said Mr. Gascho, vice president of Policy and Government Affairs for the National Health Council, Washington, D.C. “Particularly the large insurers have learned how to craft a business model in a world where pre-existing conditions are protected…they can craft their policies in ways that are going to be most attractive to a whole host of populations.”

Evidence already exists to suggest that insurers are on board with the status quo. “The major carriers, as represented by their industry associations that sell major medical coverage, have [joined existing legal challenges] saying they don’t want to roll back ACA market rules,” said Karen Pollitz, senior fellow for Kaiser Family Foundation, Washington, D.C.

During the 2020 election season, some politicians took on the issue of pre-existing conditions. Ms. Pollitz said the bills they introduced fell short of the goal. “They didn’t put back the essential health benefit standard,” which are services health insurance plans must cover under the ACA.

Mr. Belanger said some legislation exists that offers some relief, particularly for those who have contracted Covid-19. “The Family First Coronavirus Act, Respond Back Act, and the Cares Act do provide some coverage for uninsured people for Covid-19-related treatment.” But the discussion at hand -- coverage of Covid-caused conditions -- remains open, he added.

Currently, the Department of Health and Human Services has extended the ACA enrollment period, which will run from February 15 through May 15. For those who have lost employer-sponsored coverage, there are special enrollment opportunities available.

With the ACA in its current iteration, “The best thing people can be doing during this time is making sure they stay insured if they’re financially able to,” says Mr. Gascho.

Otherwise, he said, Medicaid and subsidized plans are available that can help alleviate healthcare costs. “They need to be taking care of their health, not just protecting themselves from Covid.”

Lori Widmer writes about insurance and risk management for trade and business magazines.