SCOTUS battle, presidential election will affect health care for millions

If the Affordable Care Act is overturned, millions will lose important protections

September 28, 2020 6:00 am
Baby gets medicine

The ACA has helped millions of patients like one, two-month-old Karina, receiving Tylenol after a vaccination. Photo by John Moore/Getty Images.

The possibility that the addition of a new dogmatic Republican to the Supreme Court will lead to the end of the Affordable Care Act (ACA) is not just a concern for many Americans. It is life-threatening.

Numerous studies have shown that being uninsured leads to increased death rates and premature death. We know that underinsured Americans — people with insurance policies that have limited coverage, high deductibles, co-insurance and lack of coverage of some common problems — are likely to neglect needed health care. The Kaiser Group has shown that this neglect leads to more severe illnesses than affected people with more adequate insurance coverage.

If the Supreme Court’s new conservative majority strikes down the ACA in the case before it in November, we know that roughly 25 million Americans would lose coverage. That’s 11 million who use the ACA marketplaces, 12 million insured through the Medicaid expansion and 2 million young adults insured through their parents’ policies until age 26. About 21 million would not be able to get or afford coverage to replace what they lost.

But we also face a loss of other life-saving provisions of the ACA.  

The ACA prohibits refusing to insure people or charging higher rates for people with pre-existing conditions. That applies to 166 million Americans, or roughly half of us. Although many of them are insured through work and would not lose coverage, 54 million people would likely lose their coverage and not be able to replace it.  

The ACA also requires that insurers cover certain types of critical services with no cost to the patient. These run the gamut from vaccines for flu, COVID-19 and other diseases, to colonoscopies, prenatal and neonatal care. The services are potentially life-saving and health-preserving care that people often do not get if they have to pay out of pocket. Destroying the ACA would end this coverage for many of these critical services.  

Before the ACA, insurance policies often placed an upper limit on the amount they would pay for an illness, for a year, or for the patient’s lifetime. These “coverage caps” were outlawed by the ACA. They would be back if the law is overturned.

A lot of us on Medicare would guess that we are not benefitting from the ACA. We would be wrong. The preventative health measures mentioned earlier — also including diabetes checks and once a year wellness checks — used to cost Medicare beneficiaries out of pocket before the ACA. They would cost us money again.  

The “donut hole” in drug coverage has been decreased by the ACA, and the law aims to gradually eliminate it entirely. Without the ACA, the donut hole would open wide again. The ACA also has led the way in implementing important cost-savings that have increased the life of the Medicare Trust Fund and helped hold down our out-of-pocket charges for Medicare premiums and deductibles.  

All of these apply throughout America. In Minnesota, millions of us benefit from these features. But Greater Minnesotans have benefitted especially. The Medicaid expansion enrolled so many Greater Minnesotans that the rate of uninsured in Greater Minnesota was cut in half.  Greater Minnesota hospitals often teeter on the brink of financial disaster. The expanded Medicaid, the coverage of preventative care, the expansion of insurance in the individual market, the end to “caps,” and the sharp decrease in patients who can’t afford to pay has made a big difference. The ACA has allowed many Greater Minnesota hospitals to stay open. Large hospitals in cities benefit from all of that too, but it has made a critical difference in many smaller communities.

President Donald Trump and Republicans make claims that they would “replace the ACA with something better.”  When they offered their ideas during the congressional fight over health care, the Congressional Budget Office found their “something better” left tens of millions uninsured; failed to address coverage for people with pre-existing conditions; featured extensive under-insurance; and raised costs for almost everyone over 40.

Trump’s recent “executive order” guaranteeing people health insurance despite preexisting conditions is a total fiction. It has no force of law. As Larry Leavitt from the non-partisan Kaiser Family Foundation put it, Trump’s executive order is “not a plan, it’s a mirage. It’s a series of aspirations with no specific policy proposals to back them up.”

The ACA is not perfect. Too many people buy insurance that does not provide the coverage they need. Costs of insurance for unsubsidized people have increased due to the rising cost of higher risk patients. But those are problems that can be fixed, if we get a Congress and a president who care about it.

Unfortunately, the decision on whether or not to destroy the ACA is out of the hands of everyone but Senate Majority Leader Mitch McConnell and the conservative justices of the Supreme Court.  

But if the worst happens and the ACA is destroyed, there is a solution. We need to elect a president, a House and Senate, and a Minnesota State House and Senate that will act to replace the ACA with something that is even better. In the end, that is in your hands. Vote. 

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Patrick Schoenfelder

Patrick Schoenfelder is a Minnesota physician who has made knowing about and fighting for reforms in American health care his retirement hobby.