The Affordable Care Act (ACA) is almost certainly doomed with the death of Supreme Court Justice Ruth Bader Ginsburg. Unless John Roberts and Neil Gorsuch are ready to buck conservatives this time around and find a way to split the baby—strike down the individual mandate but preserve the rest of the law—it's probably over. Which would mean millions of people would lose their coverage entirely, and millions more could find it priced out of their reach.
Those are the people with preexisting conditions, well over 100 million of them. It's likely there will be millions more of them on the other side of the coronavirus pandemic. More than 6 million Americans have had the virus, and it's already proven to have had lasting and severe lung damage. It also attacks the brain and even recovered patients are showing serious heart damage months later. We don't yet know all the ways in which this illness can damage the body, but we can be pretty sure if insurance companies aren't forced to cover it, they won't.
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Karen Pollitz, a senior fellow at the Kaiser Family Foundation (KFF), certainly sees that potential. "The question could be, 'Have you had covid in the last three months, the last six months, the last year?'" She detailed several scenarios. The companies could completely deny coverage altogether. They could deny coverage for any condition that might arise out of COVID-19—like refusing coverage for pulmonary or cardiovascular conditions—or they could hike premium costs out of reach. It would be up to states to stop it, it the ACA were invalidated. "Any of those are possible depending on the state and what’s allowed," Pollitz said.
There were just five states before Obamacare in which individual market insurers couldn't use a list of medical conditions for which they could deny coverage. Those conditions were some really common conditions: asthma, sleep apnea, pregnancy, mental health disorders, and arthritis. But even among the states that will want to keep these protections, as another KFF official points out, if the whole of the ACA is gone and the Medicaid funding and state subsidies go with it, they're not going to be able to make coverage affordable.
None of this discussion, by the way, is limited to individual insurance—these plans that are on the Obamacare marketplace. The federal protections in the law apply to all insurance, even employer-provided insurance. When those protections are gone, they're gone for everybody. It will be up to the insurers to decide again whether they'll still abide by the protections that the law created, but they won't have to.
This is what Trump, and what Sen. Mitch McConnell, are threatening. In the middle of a pandemic. That will make millions of people uninsurable if the law is gone. That's why we have to take the Senate back.