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West Virginians Watch Pre-Existing Conditions Suit With Dread

As it stands, there are no serious proposals before West Virginia lawmakers on how to deal with insurance rules over pre-existing conditions. (Dan Heyman)
As it stands, there are no serious proposals before West Virginia lawmakers on how to deal with insurance rules over pre-existing conditions. (Dan Heyman)
July 16, 2018

CHARLESTON, W.Va. — Some West Virginians with chronic illnesses are dreading a federal lawsuit over the rule that insurance companies have to cover pre-existing medical conditions.

The suit was filed by the attorney general of Texas, but the U.S. Department of Justice and West Virginia attorney general Patrick Morrisey have joined it. It aims to overturn part of the Affordable Care Act that prohibits health-insurance companies from denying coverage or charging customer’s more for illnesses such as asthma, high blood pressure or diabetes.

Culloden teacher Brianne Solomon has lupus, a serious auto-immune disease. She could lose coverage for a prescription that cost $360 every 90 days.

"There is no way I could afford that. I wouldn't be able to keep the prescriptions that basically maintain my general level of health with the disease,” Solomon said. “And people die from lupus. You can die from complications of this disease."

The suit argues that ending the rules would let insurers offer cheaper plans. Critics say without regulation, insurers could offer what's been called sham insurance, which looks good but actually covers very little.

By one count, 45 percent of West Virginia residents have a pre-existing condition.

According to Washington Post projections from a study by the Harvard Medical School, for every 500 people who gain health insurance coverage, one death per year is prevented. Solomon said without the insurance rules, people like her could be squeezed out of the market - forced to delay or do without medical care they need, but can't afford.

"I'm dreading what would happen,” she said. “If pre-existing conditions were off the table, I can't even imagine what my out-of-pocket costs would be then. I'm sure I would be what they call choked out."

The suit has been described as a long shot, but if it fails there may be other attempts to overturn that part of the Affordable Care Act.

Without the nationwide rules, insurance regulation could return to the states. Gov. Jim Justice and GOP leaders in the Legislature have said they sympathize with people who have pre-existing conditions, but none of them has put forward plans to address the issue.

Dan Heyman, Public News Service - WV