While it may seem that there is little consensus between Democrats and Republicans on some domestic issues, it’s notable that Americans across party lines agree on one important thing: People who have preexisting conditions should continue to be protected by federal health law.

In a Kaiser Family Foundation (KFF) July tracking poll released this week, registered voters ranked continuing preexisting condition protections as first among seven candidate positions on health care issues. Sixty-three percent of voters rate this issue as the “most important” or a “very important” factor in evaluating candidates. When segmented by party identification, 74% of Democratic voters, 64% of independent voters, and 49% of Republican voters say a candidate’s position on the issue is either the “most important” or a “very important” factor in their vote.

Public Policy Polling commemorated the one-year anniversary of the Senate defeat of an effort to repeal the Affordable Care Act (ACA) with survey results showing (PDF) that “a majority of voters want to support candidates for Congress who oppose repealing the Affordable Care Act.” Like the KFF poll, a majority of registered voters surveyed (64%) oppose the Trump administration joining a lawsuit that would axe the ACA’s protections for people with preexisting conditions.

The lawsuit, Texas v. United States, was filed by 20 Republican attorneys general and governors in a US district court in Texas earlier this year. And yet, residents of these Republican-led states have the most to lose. Harriet Rowan writes for Kaiser Health News that nine of the 11 states with the highest rates of preexisting conditions among adults under 65 have signed onto the lawsuit. In West Virginia, the state with the highest rate of adults with preexisting conditions, about one in three adults under age 65 “could have a hard time buying insurance through the individual marketplace without the ACA protections,” Rowan explains.

Given the breadth of health conditions that are considered preexisting conditions, concern about the pending lawsuit isn’t limited to red states. Prior to the enactment of the ACA, a person could have been deemed uninsurable if they had arthritis, cancer, diabetes, or sleep apnea, just to name a few conditions. For example, a woman named Joy told the advocacy group Indivisible Austin that she was diagnosed with stomach cancer in 2012, right after she moved from New York to Texas. She had survived breast cancer ten years prior. Because Joy’s health plan was unavailable in Texas, she was uninsurable in the state due to her preexisting conditions. “For the next six months I was in the state pool and basically self-insured until the ACA became effective in 2014,” she recalls.

Another Gender Disparity

KFF estimates that 27% of adult Americans under the age of 65 have preexisting conditions that could have left them uninsurable if they applied for individual market coverage in pre-ACA times. This population is disproportionately female — Dylan Scott writes in Vox that “women are more likely than men to have a preexisting condition,” which can include pregnancy, breast cancer, or a history of domestic violence. This means that before the ACA’s protections for people with preexisting conditions were implemented, health insurance companies could — and routinely did — charge women more than men.

Through Indivisible Austin, Megan from Kansas shared her story of unexpectedly becoming pregnant 12 years ago. The small company for which she worked didn’t have a health insurance policy, so she purchased an “awful” but affordable plan. Because her insurance considered pregnancy to be a preexisting condition, her health plan dropped her coverage. This was “totally legal,” Megan emphasizes, and she and her boyfriend could not afford to have a baby without insurance. Fortunately, she was able to get the prenatal care she needed through Planned Parenthood and a safety-net clinic. “Under the Affordable Care Act, this wouldn’t happen,” she writes. “I think it would be a huge tragedy to repeal something that not only has changed my life personally, but has helped so many of my friends and family members.”

Protecting the Protections

Some Democratic lawmakers have banded together in support of the preexisting condition protections. Vox’s Li Zhou reports that a group of lawmakers including Senators Joe Manchin of West Virginia, Joe Donnelly of Indiana, and Heidi Heitkamp of North Dakota — all states that signed onto the lawsuit — are redoubling their efforts to protect the ACA with a new Senate resolution that defends the constitutionality of preexisting condition protections. Senator Manchin said in a statement, “This resolution will allow the Senate to play the role the [Department of Justice] has refused to take on — one of defending the existing law and West Virginians with preexisting conditions.”

With midterm elections approaching, voters will be paying attention to this effort to defend the constitutionality of the ACA. The Economist reports that 22% of voters rank health care over all other issues, including the economy and jobs.

Will you or someone in your household be affected if the ACA’s preexisting condition protections are eliminated? Tell me your story via Twitter or email.

Xenia Shih Bion

Xenia Shih Bion is a communications officer at CHCF, where she helps to lead communications around the foundation’s work to create health equity. She is the founding author of the “Essential Coverage” column in The CHCF Blog. Read More

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