Editor’s note: This is the first in a three-part series on the potential repeal of the Affordable Care Act.
“The Affordable Care Act touches the lives of most Americans, and its abolition could have a significant effect on millions of more people than those who get their health coverage through it.”
That’s the conclusion of a major policy analysis by the New York Times into the possible repeal of the Affordable Care Act (or Obamacare) by the Supreme Court. The high court is expected to hear arguments a week after the presidential election in the Republicans’ latest attempt to overturn the law that provides health care coverage to about 23 million Americans.
The issue has come to the forefront since the death of Justice Ruth Bader Ginsberg, a staunch defender of the law, according to the Times, which published its analysis last month. If Amy Coney Barrett is confirmed as her replacement as expected, the conservative wing will hold a 6-3 majority on the court.
Even if Barrett recuses herself and Chief Justice John Roberts Jr. votes to protect the law as he has in the past, the court would have a 4-4 tie leaving in place the lower court opinion that ruled the law unconstitutional.
Consider the consequences of such a ruling. Many millions more people would be affected than those who rely on the law for health insurance, from nursing mothers to people who eat at chain restaurants.
As many as 133 million Americans — roughly half the population younger than 65 — have pre-existing medical conditions that could disqualify them from buying a health insurance policy or cause them to pay significantly higher premiums if the health law is overturned. That’s the findings of a government analysis done in 2017.
An existing medical condition includes such common ailments as high blood pressure or asthma, any of which would cost patients much higher premiums if they can get coverage at all.
The coronavirus has infected more than 7 million Americans and may have long-term health implications for those who become ill. It also could become part of a person’s medical history that makes it challenging to find insurance.
Under the ACA, no one can be denied coverage under any circumstance, and insurance companies cannot retroactively cancel a policy unless they find evidence of fraud. In 2019, the Kaiser Family Foundation estimated that 54 million Americans have conditions serious enough that insurers would outright deny coverage if the ACA were not in effect.
Most Americans would still be able to get coverage under a plan provided by an employer or under government programs that existed before Obamacare was enacted. But protection for pre-existing conditions is particularly important during a pandemic and economic downturn like we’re suffering now.
The need to protect people with existing medical conditions from discrimination by insurers was a central them in the 2018 mid-term elections. Democrats attributed much of their success in regaining control of the House of Representatives to voters’ desire to safeguard those protections.
Since the presidential campaign began, Donald Trump and many Republicans promise to keep this provision of the law, but haven’t said how they would do that. Before the ACA, some individuals were sent to high-risk pools operated by states, but even that coverage often was inadequate.
Trump announced several new health care executive orders last month, but analysts say his actions aren’t a plan at all. Since Obamacare was enacted a decade ago, Republicans have voted in Congress about 100 times to kill the ACA, claiming it would be replaced with a better plan. But nothing credible has been put forward as a replacement.
Of the 23 million people who either buy health insurance through the marketplaces set up by the ACA (roughly 11 million) or receive coverage through the expansion of Medicaid (12 million), about 21 million are at serious risk of becoming uninsured if Obamacare is struck down. That includes more than 9 million who receive federal subsidies.
On average, subsidies cover $492 of a $576 monthly premium this year, according to the U.S. Department of Health and Human Services. If the marketplaces and subsidies go away, a comprehensive health plan would be unaffordable for most people who would become uninsured. The states would be hard pressed to replace the $66 billion spent last year on federal subsidies with state funds.
Next: A look at the millions affected by the ACA.