The Affordable Care Act, also known as Obamacare, is likely to be struck down by the U.S. .Supreme Court, throwing health care systems and the public into crisis.
If confirmed, Amy Coney Barrett, a conservative judge, will replace Justice Ruth Bader Ginsburg and probably will be the pivotal vote in the decision. Arguments in the court case of California vs. Texas will be heard by the Supreme Court on Nov. 10. The position of the plaintiffs — Republican state attorneys general — is that the mandate to purchase coverage is unconstitutional, and therefore the entire ACA is unconstitutional.
There are three major provisions in the law that the majority of Americans have a favorable view toward keeping: coverage for preexisting conditions (supported by 62% of Americans), subsidies to make insurance affordable (supported by 87%) and Medicaid expansion (supported by 85%). All three would disappear with the stroke of a pen.
The provision receiving the most attention is the protection provided for preexisting medical conditions. If the Affordable Care Act is ruled unconstitutional, those protections go away, and insurance companies can revert to denying coverage. Medicare covers all preexisting conditions in the elderly; few realize that 27% of the nonelderly population have preexisting conditions. That translates to millions of people potentially denied coverage, and most could not afford care without insurance.
President Donald Trump signed an executive order to make covering preexisting conditions “the policy of the United States,” but without legislative action, this order is essentially worthless. Republicans have no comprehensive plan to replace the law.
The Affordable Care Act provides subsidies for nearly 11 million Americans who purchase coverage on the exchanges. Subsidies make their insurance premiums affordable. If the ACA is overturned, these people who depend on subsidies would be unable to afford health insurance. Many of these people who get sick and need care will show up on the doorstep of hospital emergency rooms because they have nowhere else to go.
Medicaid expansion is the third provision of law most important to the public. This allows states to make Medicaid available to all adults with incomes up to 138% of the federal poverty level, or individuals making $17,609 or less per year. As of June 2019, there were 14.8 million people enrolled in Medicaid expansion across 34 states. South Carolina is one of 16 states that did not expand Medicaid. If the Affordable Care Act is overturned, those 14.8 million people will be thrown into a health care system with no coverage and little ability to pay the high cost of health care in this country.
Insurance companies have adjusted to the law. They are learning how to manage the mandate to accept preexisting conditions and provide unlimited coverage. All administrative requirements are functioning. About 67% of marketplace (exchange) enrollees will have a choice of three or more insurers in 2020. Twenty-six insurers offer coverage in state marketplaces. Insurers providing care to individuals through the exchanges have realized average profit margins in 2017-19 higher than before the Affordable Care Act was implemented. It might not be optimal, but it is working.
Voters in the upcoming election should make their voices heard on this subject and demand Congress maintain their health care options. Neither Republicans nor Democrats have a comprehensive plan to lower health care costs. The Supreme Court may well create a crisis, but it cannot fix the problem. Only legislators can do that. Our health care system is already severely stressed due to COVID-19. If the Affordable Care Act is struck down in court, we are headed for catastrophe.
James H. Suddeth Jr. is the former board chairman at Palmetto Health Richland, currently Prisma Midlands, and CEO of Suddeth Healthcare Solutions.