With the number of confirmed COVID-19 cases in the U.S. surging past 9 million, two urgent questions demand our attention: What are the long-term health implications for those who acquire the virus?

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And what is the likelihood that patients with COVID-19 could be victimized a second time by health insurers who use this deadly virus to deny them coverage long after their recovery? The fact that we cannot answer either question with any certainty, eight months into this devastating pandemic, should alarm everyone now that protections for people with preexisting conditions as guaranteed in the Affordable Care Act (ACA) hang in the balance before the U.S. Supreme Court. Justices in our nation’s highest court are scheduled to hear oral arguments in California v. Texas on Tuesday, bringing to a close a lengthy court battle in which the Trump administration and a group of state attorneys general are challenging the ACA’s constitutionality. If the ACA is struck down, the impact would extend far beyond the private insurance market to disrupt policies, payment systems, the operations of Medicare and Medicaid, prescription drugs and nearly every aspect of the U.S. health care system. If the Supreme Court tosses out the ACA—stripping some 20 million Americans of their health coverage in the process—Congress must act swiftly to make the coverage of preexisting conditions the centerpiece of whatever system ultimately fills the void.

COVID-19 puts this issue in stark relief: No one should ever be denied or unable to obtain meaningful health coverage simply because of his or her medical history.

So much has changed in our health system since implementation of the ACA in 2010 that it’s easy to forget the punitive system that preceded it. Health insurers serving the individual market in almost every state could deny coverage to people with preexisting conditions, or charge higher premiums if they chose to offer coverage at all. Insurers could also issue individual policies that excluded specific diseases and could exclude coverage for specific organs or body systems affected by those diseases.

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Prior to 2010, the list of preexisting conditions that could disqualify you for insurance was largely up to the whims of the insurer. The list included chronic illnesses such as cancer, diabetes, hypertension, sleep apnea, cardiovascular disease and asthma, but also conditions such as obesity, fertility treatments, pregnancy and even prior mental health counseling.

Preexisting conditions widespread

Today, up to half of all nonelderly Americans have a preexisting condition, according to the Department of Health and Human Services, and COVID-19 survivors may potentially fall into this category.

Politics have always surrounded the ACA and slowed its progress, but 10 years after its adoption there is growing consensus among voters in both parties that the law introduced rights and protections for patients that must be maintained, regardless of the system we have in place. Aside from protecting coverage for those with preexisting conditions and removing the stigma for people who have fought bravely against a difficult illness or chronic disease, the ACA included no-cost preventive care, guaranteed policy issuance, parental coverage for young adults, and the elimination of annual and lifetime dollar limits on coverage of essential health benefits. Our AMA remains committed to the principle that everyone should have access to affordable and meaningful health insurance coverage. Though the current law is far from perfect, the consequences of throwing out the ACA or its provisions would be devastating for our country, especially as we are in the grip of an historic pandemic.

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As Chief Justice John Roberts wrote in the majority opinion issued in 2015 in King v. Burwell: “Congress passed the Affordable Care Act to improve health insurance markets, not destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

Turning back the calendar to 2009, and returning to the health insurance landscape that predated the ACA, would cost us more while making us sicker. Our nation and our health care system must look forward and build on the substantial gains we have made—and protecting and improving the ACA is a vital part of that process.

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