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Save provisions of health law

House Speaker Paul Ryan makes his case last

House Speaker Paul Ryan makes his case last year in Washington for the GOP's plan to repeal and replace the Affordable Care Act. Credit: AP / J. Scott Applewhite

The Affordable Care Act is one of the more controversial laws ever enacted in the United States, but for all the furor that accompanied its debate and passage in 2010, there were a few provisions in it that practically everyone supported.

The law made it illegal to refuse health insurance to customers with pre-existing conditions, a boon to people for whom such refusals meant not receiving needed medical care or enduring bankruptcy. And it barred using people’s health history or those pre-existing chronic conditions as a justification to charge exorbitant amounts for coverage.

It’s hard to imagine anyone fighting to return to a system that left many people with pre-existing conditions unable to buy health insurance, and many sicker and older Americans paying staggering rates, but that’s exactly what many Republican-led states and the Trump administration are doing. This is how:

After several failed attempts to repeal the Affordable Care Act, last year Republicans in Congress and President Donald Trump did succeed in repealing the “individual mandate,” which fined those who could afford health insurance but chose not buy it. The fine was eliminated as part of the federal tax-system overhaul passed in December.

But requiring everyone to either buy insurance or pay the fine was one of the ways for the system to cover the higher cost of those with pre-existing conditions. Now 20 GOP-run states are suing to overturn the remains of the Affordable Care Act, arguing that without the mandate, the entire structure of the law is flawed.

It now falls to the Justice Department to defend the law, but in a rare move, the Justice Department has sided with the plaintiff states and is arguing that the rules governing the individual mandate, pre-existing conditions and community ratings should be struck down by the courts. The contention is that without the fine for the mandate, the law can’t function as Congress intended. But Congress specifically intended the law to operate exactly this way when, last year, it repealed the fine for not buying coverage, but left the rest of the law intact.

Striking down the pre-existing condition and community ratings rules would be such a clear disaster for the health of Americans and the stability of the system that even the health insurance companies that would be allowed to exclude or charge exorbitant rates to older and chronically ill customers oppose the change. They are filing a brief arguing against it.

If the changes happen, companies that refuse coverage to chronically ill patients or overcharge the sick and elderly would be able to charge younger, healthier customers so much less that every competitor would be forced to follow suit. The insurance companies would much rather be able to supply affordable coverage to all via a system that allows them to do so without profits suffering. The Justice Department should defend the law the Republican Congress failed to repeal last year. And Trump, who in his presidential campaign frequently said he would never eliminate these protections, should make sure they are preserved.