Losing Obamacare protections during pandemic 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,” said the study’s lead author, Nathalie Huguet, Ph.D., who is also an assistant professor of family medicine in the 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.

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This study was supported by the National Cancer Institute (award P50CA244289, grant R01CA204267) and the National Heart, Lung and Blood Institute (grant R01HL136575), both of which are of the National Institutes of Health; the Cancer Moonshot; and the Agency for Healthcare Research and Quality (grant R01HS025962).

This work was conducted with the Accelerating Data Value Across a National Community Health Center Network Clinical Research Network. The nonprofit OCHIN leads this network in partnership with Health Choice Network, Fenway Health and Oregon Health & Science University. The network is funded through the Patient-Centered Outcomes Research Institute (contract RI-CRN-2020-001).

REFERENCE: Nathalie Huguet, Teresa Schmidt, Annie Larson, Jean O’Malley, Megan Hopes, Heather Angier, Miguel Marino, Jennifer DeVoe, Prevalence of Pre-existing Conditions among Community Health Center Patients with COVID-19: Implications for the Patient Protection and Affordable Care Act, Journal of the American Board of Family Medicine, February 2021, DOI: 10.3122/jabfm.2021.S1.200571, https://www.jabfm.org/content/jabfp/34/Supplement/S247.full.pdf.