Las Vegas Sun

October 19, 2019

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Nevada AG: State has plenty of reasons to defend the ACA


Wade Vandervort

Nevada Attorney General Aaron Ford speaks during a press conference Monday, July 1, 2019. Ford is awaiting a decision from the U.S. 5th Circuit Court of Appeals, which is weighing a case testing the constitutionality of the Affordable Care Act. Nevada is one of 21 states with Democratic attorneys general urging reversal of a lower-court decision.

As a panel of federal appeals court judges weigh a lawsuit questioning the constitutionality of the Affordable Care Act, some of Nevada’s top elected officials are pointing out just how residents of the Silver State would be affected.

Nevada Attorney General Aaron Ford, who intervened in the lawsuit soon after taking office in January, said Nevada should assist in defending the ACA for “several reasons, and all of them are because of the effect that it would have on Nevadans.”

“The federal government has abdicated its responsibility in this regard,” he said. Opponents of the ACA — attorneys general of 18 Republican-leaning states filed the suit in 2018 — based their argument on the 2017 Republican tax overhaul, which set the ACA’s individual mandate — the penalty those who were uninsured had to pay each year to the federal government — to $0. In 2012, the U.S. Supreme Court upheld the ACA because it was a “valid exercise” of Congress’ taxing power, and opponents of the law argue that without a penalty, the mandate is not a tax, and therefore unconstitutional. If the mandate is unconstitutional, they argue, so is the rest of the law.

The law’s defenders disagree, with some legal scholars arguing that by leaving the rest of the health law standing, Congress inherently said the mandate was severable from the rest of the Act.

Almost immediately after Tuesday’s hearing, most of Nevada’s congressional delegation — save sole Republican Rep. Mark Amodei — spoke out against the efforts to end the law.

Rep. Steven Horsford said in a release that he would work with Ford and Gov. Steve Sisolak in defending the legislation. Horsford touted Nevada’s status as the first state with a Republican governor to expand Medicaid under the ACA back in 2014 under then-Gov. Brian Sandoval.

“(The Trump administration) tried and failed to pass legislation that would have repealed the ACA and ripped health coverage from millions of Americans while raising health care costs across the board,” Horsford said in the statement. “Now, they’re trying to use the court system to take away people’s health care.”

Sen. Catherine Cortez Masto spoke out against the lawsuit on the U.S. Senate floor.

“One of the most important parts of the ACA is its guaranteed protections for people with pre-existing conditions,” she said. “Insurers used to be able to discriminate against people because of their medical history.”

Rep. Susie Lee spoke at a Battle Born Progress event the day before oral arguments, saying she had seen first-hand what the stress of not being able to afford health care can do.

“My father was laid off at the age of 56 and was unable to find full employment with full benefits after that,” she said. “He and my mother struggled, they were in that donut hole and struggled and because they both had (a) preexisting condition of high blood pressure, they were unable to afford insurance and my mother suffered a heart attack literally one month before she qualified for Medicare.”

Here are some of the ways losing the ACA would affect Nevada.

Loss of health care coverage

According to data from the Economic Policy Institute, 371,000 Nevadans would lose health care coverage, a 95% jump in the uninsured rate.

Nevada would see the highest loss of health care coverage by sheer population amount among the 10 states with the closest population.

Pre-existing conditions

The ACA made it illegal for insurance companies to deny coverage or charge higher premiums for people with pre-existing conditions.

According to the Center for American Progress, more than 1.2 million Nevadans — pretty much evenly divided among the state's four congressional district — have some form of preexisting condition. If the ACA is overturned, many of those people could be priced out of insurance coverage.

Rural insurance rates

Nevada has seen the second-largest percentage increase of low-income rural residents becoming insured in the nation since passage of the ACA.

While some similarly-sized states such as Mississippi and Arkansas saw a 5% and 6% increase of insured low-income rural residents, Nevada experienced a 28% increase. The only state with a higher increase among all 50 states was Colorado, at 29%, according to a joint study from the Georgetown University Health Policy Institute Center for Children and Families and the University of North Carolina North Carolina Rural Health Research Program.

“These are obviously fantastic numbers for the state of Nevada,” Ford said.

Nationwide implications

If the trial court decision stands, the number of uninsured people in America would increase by almost 20 million, or 65%, according to the Urban Institute, a left-leaning research organization. That includes millions who gained coverage through the law’s expansion of Medicaid, and millions more who receive subsidized private insurance through the law’s online marketplaces.

Insurers would also no longer have to cover young adults up to age 26 under their parents’ plans; annual and lifetime limits on coverage would again be permitted; and there would be no cap on out-of-pocket medical costs people have to pay.

Also gone would be the law’s popular protections for people with preexisting conditions. Without those protections, insurers could return to denying coverage to such people or to charging them more. They could also return to charging people more based on their age, gender or profession.

The Kaiser Family Foundation, a nonpartisan research organization, has estimated that 52 million adults from 18 to 64, or 27% of that population, would be rejected for individual market coverage under the practices that were in effect in most states before the ACA.

The appellate court decision could take months to decide the case. The case is likely headed to the Supreme Court, where the same five-justice majority that has twice voted to uphold the law — in 2012 and 2015 — remains in place.

The Sun’s wire services contributed to this report.