Editor’s note: This is the second in a three-part series on the potential repeal of the Affordable Care Act.
The U.S. Supreme Court is expected to hear a case a week after the presidential election on the constitutionality of the Affordable Care Act, commonly known as Obamacare. The case arises from a federal judge in Texas ruling the act is unconstitutional.
Given the appointment of a new associate justice, the conservative wing in the court will hold a 6-3 majority, making it possible the court will uphold the ruling. Should that happen, about 21 million Americans are at serious risk of becoming uninsured. Here’s a breakdown of the people who rely on the ACA for health care benefits as reported in the New York Times:
The largest group is Medicaid recipients, a program jointly funded by the federal government and states. According to the Urban Institute, Medicaid enrollment would drop by more than 15 million. This includes about 3 million children who got Medicaid or the Children’s Health Insurance Program (CHIPS) when their parents signed up for coverage.
Losing free health insurance means worse access to health care and probably worse health for the millions affected. Studies have found that Medicaid expansion has led to better access to preventative screenings, medications and mental health services.
If Obamacare is struck down, about 60 million people covered under Medicare for people age 65 and older or people of all ages with disabilities also would be affected. Medicare recipients would have to pay more for preventative care such as a wellness visit or diabetes check that are now free.
They also would have to pay more toward prescription drugs. About 5 million Americans faced the so-called Medicare doughnut hole, or coverage gap, in 2016, which the ACA sought to eliminate. If the law is overturned, the coverage gap would widen again.
Doctors and hospitals could lose a crucial source of revenue as more people lose insurance coverage during an economic downturn like the nation is experiencing from the coronavirus. Without the ACA, the Urban Institute estimated the cost of care for people who cannot pay could increase as much as $50.2 billion.
Hospitals and medical providers already are struggling from the higher costs from the pandemic, and any loss for uncompensated care could push them into insolvency. Scores of hospitals in rural America have closed in recent years due to uncompensated costs for medical care.
The ACA also protects many Americans from caps that insurers and employers once used to limit how much they had to pay out in coverage each year or over a lifetime. Before the pandemic caused widespread job loses, some 150 million Americans had health care coverage from an employer. The elimination of caps protected those employees plus about 15 million enrolled in Obamacare or other plans.
Employers are required to cover their employees’ children younger than 26, and it’s one of the most popular features of the law. Roughly 2 million Americans are covered under the parent’s insurance plan. If Obamacare is struck down, employers who have to decide if they would continue this coverage and most experts predict they likely would.
The ACA took effect just as the opioid epidemic was spreading to all corners of the country. Health officials in many states say that one of Obamacare’s biggest benefits has been providing access to addiction treatment. The law requires insurance companies to cover substance abuse treatment and that could stop of the law was struck down.
The biggest group to get access to addiction treatment is adults who have gained Medicaid coverage. The Kaiser Family Foundation estimates that 40% of people from ages 18 to 65 with opioid addiction — roughly 800,000 — are on Medicaid.States with expanded Medicaid are spending much more on medications that treat opioid addiction than they used to. Medicaid spending on prescriptions for two medications has more than double. In 2017, the latest year figures are available, medication cost $887 million, up from $358 million in 2013.
Menu labels are among dozens of the law’s provisions that are less well known. The ACA requires nutrition labeling and calorie counts on menu items at chain restaurants. It also requires many employers to provide “reasonable break time” and a private space for nursing mothers to pump breast milk.
Next: A look at Trump’s health care ploy before the election.