It's been nearly three months since state Rep. Brenda Shields was diagnosed with COVID-19, but her lung issues still persist.
Shields said she feels her condition improving every day, but she still has difficulty breathing - especially when she exerts even a small amount of energy.
Lawmakers are concerned the pandemic will add to the more than 1 million Missourians with pre-existing conditions, making it more difficult for them to obtain health insurance if a GOP-led effort to overturn the Affordable Care Act is successful before the U.S. Supreme Court.
In preparation for that possibility, Republican lawmakers have filed a trio of bills that would give voters the opportunity to amend the state Constitution to add protections for children and adults with pre-existing conditions.
"I think the amount of Missourians with a pre-existing condition - because of COVID - will only increase," Shields, R-St. Joseph, said. "I absolutely believe that we do not yet know everything that COVID has done to our bodies."
Legislation filed by House Majority Floor Leader Dean Plocher, R-St. Louis, would have voters decide whether to prohibit health insurance providers from excluding benefits, denying coverage or charging residents more as a result of their pre-existing conditions.
Shields' joint resolution, and its Senate companion, sponsored by Sen. Karla Eslinger, R-Wasola, would offer similar protections and also include language requiring health insurance plans continue to allow coverage for children on their parents' plans until they turn 26 years old.
If the Legislature approves any of these measures, the question would go on the statewide ballot in 2022, with protections going into effect Jan. 1, 2023.
Insurers are already prohibited from using pre-existing conditions as a reason to deny coverage or charge more under the federal Affordable Care Act, better known as Obamacare, which was approved in 2010 under President Barack Obama.
Missouri is one of 18 states challenging the law before the U.S. Supreme Court. The coalition of states challenging the Affordable Care Act argued if the individual mandate provision of the law is unconstitutional, then the entirety of the act must fall with it.
The Supreme Court is expected to issue a ruling by the end of June 2021.
"I want to make sure that if the Affordable Care Act is overturned, that Missourians have the peace of mind to know that pre-existing conditions are going to be covered under their insurance plans," Plocher said.
Others are quick to point out Missouri wouldn't need to add these protections to the state Constitution if Republicans weren't trying to gut them at a federal level.
"I hope we don't have a gap," state Rep. Sarah Unsicker, D-Shrewsbury, said. "I would rather see Missouri not try to overturn the Affordable Care Act."
Pre-existing conditions are any health condition a person has before enrolling in a health insurance plan, such as diabetes, cancer, pregnancy, or sometimes even less severe conditions like acne or sleep apnea.
At some point in life, most people will have a pre-existing condition, Plocher said. Ensuring health care is affordable and accessible for people with pre- existing conditions will help them access preventive care and stave off worsening conditions and higher medical bills down the road, he said.
"By mandating that pre-existing conditions are covered, I see the equitable way to go about this is to do what insurance is crafted to do," Plocher said, "and that is to spread the risk across the entire population, so that the population bears the burden as a whole, rather than just those that are burdened with some health condition, whether it be high blood pressure, diabetes, cancer."
A 2019 analysis by the Kaiser Family Foundation, a nonpartisan nonprofit that focuses on national health issues, estimated about 1,079,000 Missourians from 18-64 years old had pre-existing conditions in 2018 that previously would have been considered "declinable" - about 30 percent of the state's non-elderly population.
The average for the country's non- elderly population as a whole was 27 percent, or nearly 54 million people, under KFF's analysis. A 2017 analysis by the federal government put that number as high as 133 million people.
Protections for pre-existing conditions are one of the Affordable Care Act's most popular provisions - although support is lowest among Republicans, with 62 percent of those surveyed in a July 2019 poll by KFF saying it's "very important" they remain in place.
Shields said most Missourians have an older adult in their family whom they've seen pre-existing conditions affect or heard of their parents' trials with health insurance. And it's important protections be passed as a constitutional amendment, Shields said, so "it leaves families some certainty to know that things won't change every year."
Plocher said adding protections for pre-existing conditions is a simple, common-sense measure, and he didn't want it "to be held hostage" if it went through the typical legislative process as a bill passed into law.
"I want it to be a straight up or down vote," Plocher said. "And I think the people should decide this matter of importance."
Unsicker said the bill still leaves some holes open for insurers to find other grounds to cut people off of insurance. But on its face, the ballot language would likely have broad support - but it also depends on how money may be spent to oppose it, Unsicker said.
"If people just see it on a ballot, I think that they would support it," Unsicker said. "But it depends on what they're told about it beforehand, and I'm afraid the insurance companies might not want to see this."
Ultimately, Shields said, voters should have the choice to decide.
"I truly believe that Missourians care for other Missourians," Shields said, "and they want to make sure that everyone has an opportunity to have health insurance."
The Missouri Independent is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.