You must admit: Sen. Thom Tillis is in a tough spot. After saying time after time  that the Affordable Care Act is the root of virtually all that is wrong in the world, and voting repeatedly to repeal it , Tillis now finds himself face-to-face with an electorate that supports the ACA, and overwhelmingly supports provisions such as one that prohibits insurance companies from denying coverage based on preexisting conditions.
So, what’s a conservative senator in a purple state coming up for election in 2020 to do? If you’re Tillis, it seems the answer is to mislead his constituents while giving insurance companies exactly what they want.
This summer, Tillis was the primary sponsor of a bill  that, at least at first glance, seems to protect Americans from the predatory practice of denying health insurance based on pre-existing health conditions. The bill even mimics the text of the ACA, saying the denial of coverage based on “health status, medical condition (including both physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), disability, [or] any other health status-related factor determined appropriate by the Secretary [of Health and Human Services],” is prohibited.
Sounds great, right? But the problems with the bill start when you realize what it doesn’t say. What this bill does not prohibit, for example, is offering a cancer survivor a plan that simply does not cover cancer. It also would not prohibit an insurance company from offering that same cancer survivor a plan that covers cancer-related treatments, but happens to cost that person 100 times what it would cost a cancer-free applicant. In other words, it completely strips out the actual protections for those with pre-existing conditions, and allows insurance companies to set the rules. It’s a return to the bad old days.
More than 50 million Americans have something in their medical histories that could disqualify them from health insurance absent the Affordable Care Act’s rules, according to the Henry J. Kaiser Family Foundation, a nonprofit research organization that focuses on national health issues. In other words, those with the greatest need for health care would again face the biggest obstacles to getting it.
But this wouldn’t affect only people with histories of serious or chronic illnesses, such as cancer. Women who have experienced postpartum depression, or underwent Caesarean sections, could be tagged as having pre-existing conditions. In fact, more than half of women and girls nationwide—more than 67 million—have what Tillis’ friends in the insurance industry would consider pre-existing conditions.
These consequences would extend beyond those consumers who currently get their health insurance from the Affordable Care Act’s exchange marketplaces or directly from insurers. People who have health benefits from a large employer wouldn’t see their coverage disappear, but new employees could have to wait months for their coverage to start or shoulder the costs of any medical conditions they had before joining a company. Employees at small companies could face higher premiums because insurers could go back to setting rates based on the health status of the workers on these plans.
But why would Tillis and his cronies go through this elaborate charade to deceive voters in the first place when the protections of the ACA are still in full-force? Because Republican are now attempting to use the courts to achieve what they failed miserably to do legislatively: repeal the ACA.
Republican officials from 20 states are suing to overturn the entire Affordable Care Act , which would include its provisions guaranteeing access to insurance for people with pre-existing conditions. The case, Texas v Azar, has the potential to upend the ACA and gut the very protections that are the most popular. And now, thanks to the ruling of a federal district court judge in Texas last Friday , the plaintiffs got exactly what they wanted. We once again have to confront the prospect that gains under the Affordable Care Act could be taken away.
President Donald Trump’s Justice Department decided not to defend the ACA law in court, saying it agreed with the premises of the lawsuit. To say the least, this is not the normal way the department handles cases challenging federal laws. The administration, however, doesn’t want to throw out the whole law, only the parts that protect people with pre-existing conditions. Of course.
All of this brings us back to Senator Tillis and his very bad bill. In an attempt not to look like the bad guy, he created a bill that has the appearance of protecting people, but actually allows insurance companies to cherry-pick the healthiest, least expensive people to cover, all while forcing the rest of us to do without the affordable coverage we need. We shouldn’t be surprised. It was, after all, under Tillis’ “leadership ” that the North Carolina General Assembly passed the law prohibiting North Carolina from expanding Medicaid, thereby denying quality and affordable coverage to more than 500,000 residents.
Now he’s trying to do that same thing again, but this time for the entire country. But it doesn’t matter how much you try to deceive us, Senator Tillis – we know your true allegiance is with the insurance companies , not with the rest of us who have been at their mercy for far too long.
Kevin J. Rogers, JD, is the director of policy and public affairs for Action NC  and a lecturer of government and political science at William Peace University in Raleigh.