The news that the Supreme Court will decide whether or not to strike down the Affordable Care Act in the first half of 2021 sure does make the 2020 election even more fraught. That the news falls in the middle of a public health crisis takes that up to 11. There's so much at stake that voters, already with health care at the top of their agenda, will be taking to the polls with them. Knowledge is power. So in light of that, let's talk about the heart of the challenge and what it could mean for health care.
The legal challenge is based in the GOP Tax Scam of 2017 (thanks for your vote for that, Susan Collins), when Congress eliminated the tax penalty for people who refused to purchase health insurance, the individual mandate of Obamacare. With Texas in the lead, Republican states challenged the constitutionality of the whole law on the basis that the individual mandate was the underpinning for the entire thing. This, by the way, is an argument that every serious legal mind considered ridiculous; the case was bogus. That didn't stop the Trump Justice Department, in a complete departure from normality, from joining in that argument. For many reasons, too detailed to go into here, there really isn't a valid legal basis for the case. There’s a very political one if you hate President Barack Obama and thus the law, but not a jurisprudential one. On the basis of this ridiculous argument, a highly, highly partisan Republican judge decided to make his own law, and a higher court, also loaded with conservative ideologues, agreed. So here we are, but what does that potentially mean for health care?
A lot. As we sit here in March 2020 with the COVID-19 virus threatening to become a global pandemic, the first thing comes to mind: The ACA requires that insurance companies cover vaccinations with no deductibles and no co-pays. There isn't a coronavirus vaccine yet, but when there is, it will have to be paid for by your insurance. That's the immediate part. Then there's the part where millions of people have insurance at all because the law makes it affordable. That includes somewhere in the vicinity of 14 million newly covered people right now. There are about 12.7 million people enrolled in individual plans that provide free preventive care. There are more than 150 million who have the free preventive care—including vaccinations—through their work insurance, because the law required that it be covered.
What else is at stake if the law is overturned:
- Coverage for people up to age 26 on their parents' plans (about 2.3 million).
- Coverage of 54 million nonelderly people's pre-existing health conditions, more than a quarter of the working-age population.
- Coverage of essential health benefits such as prenatal care, mental health and substance abuse care, and prescription drugs.
- No limits on what insurance companies have to spend on on your care.
- Caps on out-of-pocket expenses.
- The requirement that large companies provide health insurance.
- Prescription drug savings for Medicare enrollees.
- Free preventive care services for Medicare enrollees.
That's just some of the provisions of the law. There's so much more at that link.
Granted, not all of these provisions worked for everybody the way that they were supposed to. If they had, we wouldn't still have GoFundMe campaigns to cover the costs of people's health care, and we wouldn't still have millions of uninsured people. Candidates also wouldn't still be talking about the need for further healthcare reform on the campaign trail.
The ACA has changed the healthcare system in innumerable ways at every level. It has become so fully enmeshed in every aspect of it at every level that yanking it out would be far more disruptive to the system than implementing it was. That's got to be in the minds of at least a few Supreme Court justices this day, counterposed against the headlines of the emerging health crisis. We're a long way from this fall, when this case will be heard, or next spring, when it will be decided. But one thing we know for certain: The court's announcement now that it’s taking it on will reverberate all the way through November's election.