By Simon F. Haeder
More than 10 years after its passage , the Affordable Care Act once more hangs in the balance.
There have been plenty of near misses before, including previous Supreme Court appearances and Congressional votes. Yet in the wake of Justice Ruth Bader Ginsburg’s death, this time around Republicans may finally be successful in undoing the Obama Administration’s signature achievement.
Hearings before the Supreme Court are scheduled to begin on Nov. 10 on whether a change in tax law makes the ACA unconstitutional.
The ACA can be improved in many ways, as I have written elsewhere . Yet if the Supreme Court strikes down the ACA, it seems unlikely to me that a meaningful replacement will be put in place among high levels of partisanship in Washington, D.C.
As a result, if the court kills it virtually all Americans would be affected by the policy reversal, as the almost 1,000 pages of legislative text and ensuing more than 9,000 pages in regulations have impacted all parts of the American health care system.
As a health policy and politics scholar who has published extensively on the ACA, I see the following as the most obvious effects if the Supreme Court ruled the ACA unconstitutional.
One of the key features of the ACA was the expansion of insurance to millions of Americans. Most of this was achieved through the expansion of the Medicaid program , America’s safety net program.
Additionally, the ACA provided insurance market reforms and subsidies that made it easier to buy health plans for those Americans making too much to quality for Medicaid.
Millions of young Americans able have been able to also stay on their parents’ coverage until they turn 26.
More than 20 million Americans will lose their insurance if the ACA is undone.
Even before COVID-19, many medical providers including hospitals and clinics were struggling to keep their doors open . This particularly applied to those located in poorer and more rural areas of the country. Indeed, hospital closures since 2010 have mostly occurred in states that have refused to expand their Medicaid program, like Texas and Alabama. These pressures would be gravely exacerbated with millions of Americans losing coverage.
Closures affect all community members , whether they have insurance or not, as residents lose access to hospitals and specialists.
Before the ACA became law, many Americans were frequently turned down when they went to buy insurance . The insurance carriers deemed them too much of a financial risk due to their “pre-existing conditions.”
Before passage of the ACA, this practice was subject to a confusing mix of state and federal laws, regulations and enforcement. Insurers developed lists of conditions, medications or occupations that would lead to an automatic denial of insurance coverage.
These “declinable conditions” including diverse issues ranging from substance abuse to acne. Many insurers also refused to cover victims of rape , and 45 states allowed the practice for C-sections. In total, a congressional report found that 425 medical diagnoses have been used to decline coverage.
It seems like that exposure to COVID-19 would now also fall into this category. And, it’s far from certain whether so-called COVID long haulers would be covered.