COVID-19, the New Pre-Existing Condition, and the ACA.

During the pandemic, many Americans have relied on the Affordable Care Act (ACA) to help with testing, treatment and to cover expenses possibly related to COVID-19, a soon to be “pre-existing” condition. The COVID-19 pandemic has affected Black Americans and many other people of color exceptionally hard in the United States. The Supreme Court is set to rule on whether the ACA is unconstitutional and that puts the future of health care for millions at risk, especially Black Americans.

A pre-existing condition is any medical illness or injury you have prior to beginning a new health care plan such as diabetes, COPD, cancer, and even Sleep Apnea.  They tend to be chronic, long term, or both. Before the Affordable Care Act (ACA), a pre-existing health condition, such as a severe respiratory illness (COVID-19, is a contagious respiratory illness), making it harder or even impossible for people to get and keep private health insurance.  According to the DHHS, 19 to 50 percent of non-elderly Americans have some pre-existing health condition. Up to one in five non-elderly citizens with pre-existing conditions are uninsured. Under the Affordable Care Act (ACA) Americans could not be denied coverage, charged higher premiums, or have their benefits reduced by insurance companies.

COVID-19 ACA Chicago DefenderBefore the ACA, people of color were more likely to be uninsured than Whites. Although many have at least one full-time worker in the family across racial and ethnic groups, many do not have an employer’s medical coverage or have difficulty affording private coverage when it is available. While Medicaid helped with coverage for people of color before the ACA, for parents, Medicaid eligibility became limited to those with low incomes (often below 50% of the poverty level). Adults without dependent children regardless of income were ineligible under federal rules. ACA and Medicaid expansion to low-income adults helped to narrow but did not eliminate disparities in health coverage. The loss of the Medicaid expansion would likely lead to disproportionate coverage among Black and Hispanic individuals, contributing to widening inequalities in medical coverage and access to medical care.

If a newly insured person is diagnosed with COVID-19, an insurer might exclude coverage for the condition. If a person who buys an individual policy when she/he is newly (and unknowingly) infected by the coronavirus and becomes sick shortly afterward, may find that their insurer will refuse to pay for any COVID-19 treatment because the condition would be considered ‘pre-existing.’

Before the ACA, health insurance could discriminate based on a person’s health condition, previous medical history, and other risk factors. For example, someone who applies for medical health insurance while sick or after battling an illness such as  COVID-19 may be turned down, charged more, or offered a plan that excludes coverage for COVID-19 or related symptoms. Even getting tested for the coronavirus could also be used in denying health care.

Twenty-five percent who have tested positive for COVID-19 are Black people even though Blacks make up just 15 percent of the general population. If the Supreme Court overturns the ACA and can deny health care to those with pre-existing conditions, amid a pandemic, this could widen racial disparities in health care.  The timing could not be worse when there is a growing focus on equity in healthcare.

Without the ACA coverage and subsequent expansions, people of color would face larger healthcare coverage gaps.  The Supreme Court is scheduled to rule on the fate of the Affordable Care Act on November 10, 2020, one week after Election Day.

Shera Strange is a Fitness Professional and Writer. Find her at

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