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Pennsylvania Attorney General Josh Shapiro demanded the Trump administration to clarify its position regarding the implementation of certain provisions of the Affordable Care Act (ACA).

On Monday, Shapiro sent letters to U.S. Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex Azar regarding the matter.

In the letters, Shapiro raised concerns about the latest court filing by the Department of Justice regarding ACA. He noted that the DOJ did not defend the healthcare law’s provisions related to pre-existing conditions and preventing discriminatory pricing.

Contradicting Positions on ACA Provisions Created Confusion

Additionally, Shapiro told Sessions and Azar that their positions on those provisions are contradictory, creating confusion among regulators, insurers and patients.

In his letter to Sessions, Shapiro noted the U.S. attorney general recently stated that ACA’s guaranteed issue and community rating provisions “will become invalid as of January 1, 2019.” He also stressed that Sessions declared that the DOJ will no longer defend the constitutionality of those provisions in court.

The guaranteed issue provision requires insurers to cover individuals regardless of their health status. The community rating provision prohibits discriminatory pricing.

“Your refusal to defend them in court jeopardizes the coverages of millions of Pennsylvanians,” Shapiro told Sessions.

In his letter to Azar, Shapiro noted the HHS secretary’s remarks that the agency will continue to enforce both provisions. During a Senate Finance Committee hearing, Azar testified, “We are operating the 2019 program under existing authority, existing interpretations as of everything is remaining as it is.” Azar added that HHS is “doing everything to keep stability in the program.”

Currently, around 5.4 million Pennsylvanians with pre-existing conditions have health insurance. More than a million Pennsylvania residents receive insurance through the ACA marketplace and Medicaid. The uninsured rate in the state has declined to its lowest level ever, at 5.6 percent.

Shapiro emphasized, “Pennsylvanians need assurance now that the vital protections guaranteed under the ACA will not be taken from them.”