Pre-existing conditions affect 130 million people across this country, ranging from those with histories of serious chronic conditions, such as cancer or heart disease, to common ailments like high blood pressure and asthma. Maintaining pre-existing condition protections continues to be a top issue when voters are polled on health care concerns.

While President Trump continues to claim that “he has a plan” to replace the ACA and touts his  commitment to protecting consumers with pre-existing conditions, his administration’s actions provide us with the real story. The administration is flexing its administrative and judicial muscles to limit access to health coverage and deny people with pre-existing conditions access to care.

Below are key pieces of the Trump administration’s attacks on people with pre-existing conditions:

The Department of Justice pivots to invalidate the ACA, putting people with pre-existing conditions at risk of losing coverage or facing higher premiums and out-of-pocket costs.

The oral arguments for Texas v. United States are around the corner. On July 9, the Department of Justice will join lawyers representing 17 Republican-led states to argue for the end of protections for pre-existing conditions as well as the complete dismantling of the Affordable Care Act (ACA). At its core, this lawsuit would have devastating effects on the lives of million individuals in the country. For a recap on this case, see our recent blog. Advocates can continue to make noise both during July recess and on the day of oral arguments by amplifying the harm for people with pre-existing conditions (losing the whole ACA).

The Trump administration recently took another step to sanction health care discrimination.

Last month, the Trump administration released a proposed federal rule that undermines enforcement of the non-discrimination provision of the ACA (section 1557). As EIizabeth Taylor at the National Health Law Program put it, this is a “denial of carerule [that elevates] the right to refuse to provide health care over the right to receive it.”

Under this proposed rule, women, LGBTQ+ people, people with disabilities and people with limited English proficiency would face barriers or potential discrimination when accessing care. In addition, insurers would be allowed to use discriminatory plan benefit design to dissuade people with pre-existing conditions from enrolling. For instance, if this rule was finalized as it’s currently written, insurers would be able to exclude providers that treat high-cost conditions (such as cancer) from their provider network. They would also place most or all drugs that treat a specific condition on the highest cost-sharing tiers and refuse to cover commonly prescribed treatments (such as single-tablet drug regimens) . This means people with HIV/AIDS and other serious or chronic conditions would see their premiums and prescription drug costs skyrocket at an exorbitant level, or they would be denied coverage altogether. For an in-depth analysis of the impacts of this proposed rule, check out Katie Keith’s Health Affairs Blog and the Q&As from the National Health Law Program.

Last year, the Trump administration allowed the expansion of short-term-limited-duration plans as an alternative to comprehensive coverage sold on the Affordable Care Act’s (ACA) marketplaces.

The Trump administration’s promotion of short-terms plan raise costs for people with pre-existing conditions. By expanding this type of coverage, the administration creates an uneven playing field in which younger, healthier consumers flock to the less expensive, yet bare-bones plans forcing older and less healthy patients to pay higher premiums for the comprehensive coverage they need. Researchers at the Center on Health Insurance Reforms (CHIR) detailed the impacts of these subpar insurance plans here.

These are just a few examples of the policies the Trump administration is promoting that will harm people with pre-existing conditions. To be clear, the ultimate goal of this administration is to undermine the ACA. We must continue to be loud and united. Whenever possible, we should make sure to elevate the voices of the people who are and will be adversely affected by these policies. Nothing is more powerful than hearing stories of how the ACA has positively improved health outcomes and provided financial security for millions of Americans.