The conservative, and very political, 5th Circuit Court of Appeals finally handed down a decision last week on the Affordable Care Act. Showing just how political it is, it gave the Trump administration part of what it asked for, but not everything. Because while Trump might not be bright enough to realize how disastrous it would be for Republicans to have the entire law struck down in an election year, this court is. So it punted on the big question: Is the individual mandate, which it just declared unconstitutional, so integral to the structure of the law that the entire thing must also fall? The people who wrote it, including some Republicans, think that that argument is ridiculous. Or at least they want you to think that now, even after they've taken a bazillion votes to repeal the law. They want you to think they're defending it because they saw what happened in 2018. They know that the protections it provided, particularly to people with pre-existing health conditions, are not just popular, but essential.
Now that's all in jeopardy. It's important to realize that it's not happened yet—the law is still in effect. But it is in jeopardy, and with it health insurance for millions. The Kaiser Family Foundation has broken down the numbers. One of the groups that made the largest gains under the law, and the one least likely to get any kind of insurance if the courts take it away, is Medicaid recipients. By fiscal year 2017, there were more than 17 million new enrollees in the 32 states that expanded the Medicaid program, and 12.7 million of them were eligible for the first time thanks to that expansion. If the law is struck down, that's 17 million people who will become immediately uninsured and will be likely to stay uninsured.
There are another 14.8 million who've either received policy premium tax credits or cost-sharing reductions in marketplace plans as of February 2019, making health insurance affordable for them. There are about 2.3 million young adults who've been covered by their parents' plans because the law required it. Not all of those who would lose coverage in these groups would be locked out of it should the law fall, but a significant percentage would become uninsured again—that's a given.
Then there are the 54 million people—more than a quarter of the nonelderly population—who have pre-existing conditions that would have been "deniable" in the individual insurance market before the ACA. That means, if the law is struck down, they could be denied coverage entirely, or treatment for the specific pre-existing condition (and related ones) wouldn't be covered. Again, that's more than one-quarter of the non-Medicare population, in 45% of the nation's nonelderly families. That puts almost half of America's families in economic jeopardy, once again facing astronomical bills for treatment for pre-existing conditions or risking their health and possibly their lives by not getting treatment.
Not scary enough? How about the 133 million people who have had free preventive services provided by their employer-sponsored plans. That's millions of people who've stayed healthy with immunizations, or had serious illnesses or chronic conditions caught early through annual wellness exams, all provided without additional copays. Another 12.7 million people in ACA plans have those free preventive services that help keep them healthy. Here's a nugget from the KFF files: "Prior to the ACA, 1 in 5 women reported that they postponed or went without preventive care due to cost." That includes breast and cervical cancer screenings. It also includes contraceptive services. Another KFF data point: "The share of reproductive age women with private insurance reporting that their insurance covered the full costs of their prescription contraception rose from 45% in 2013 to 75% in 2017."
There's so much more! Before we had the ACA, 75% of nongroup health plans didn't cover maternity care. And 45% didn't cover substance abuse treatment, while 35% didn't cover mental health services. Before the law, almost 60% of employer-sponsored plans had lifetime limits, meaning a critical or chronic illness would no longer be covered after treatment for it had reached that cap. Millions of seniors with Medicare Part D coverage for prescription drugs have saved millions of dollars with their coverage, thanks to the phaseout of the "doughnut hole" coverage gap. The ACA has saved Medicare billions, extending the program's solvency and improving coverage.
All of this is objectively good, unless you're a Republican. It's because of Republicans that it is all in jeopardy—that our entire health system, representing nearly one-fifth of the nation's economy, could be headed for turmoil. This is not something most Republicans running for reelection want to contemplate, and it’s something we can't let them forget.
