Health Action New Mexico

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Pre-Existing Conditions

 

The Problem

The Trump administration has filed a lawsuit with two claims to dismantle main provisions of the ACA: first, that the removal of the penalty for failure to maintain minimum essential coverage through the passage of the TCJA renders the mandate itself unconstitutional; second, that the guaranteed issue and community rating provisions are “inseverable” from the mandate, and therefore also unconstitutional. The DOJ has announced that it does not intend to defend the existing law.

Return to pre-ACA market

Without these provisions in place, insurance companies will return to the practice of denying coverage based on pre-existing conditions, and charging prohibitively higher premiums based on factors like age and gender. 

Premium Subsidies Not Calculable

Community rating sets standard pricing across the individual marketplace based on a benchmark plan. Without this, there is no mechanism to calculate premium subsidies for lower-income families. 

Marketplace Layout Not Possible

The standard pricing set by community rating also allows the online marketplace to exist with real-time coverage and price comparisons. If community rating is repealed, applicants will again have to submit health histories for each plan and carrier separately. 

The Solution

Replicate ACA protections, including guaranteed issue and community rating, into New Mexico state law.

Policy Status

Legislation was passed through the New Mexico legislature during the 2019 session enabling the Office of the Superintendent of Insurance to include pre-existing conditions protections in the state Insurance Code. For more information, email

News and Resources

Bloomberg Law: Obamacare Protections Copied in New Mexico State Law

https://news.bloomberglaw.com/health-law-and-business/obamacare-protections-copied-in-new-mexico-state-law

Kaiser Family Foundation: Estimated Number of Nonelderly Adults with Declinable Pre-existing Conditions under Pre-ACA Practices

https://www.kff.org/other/state-indicator/estimated-number-of-non-elderly-adults-with-declinable-pre-existing-conditions-under-pre-aca-practices/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D