The big question, from a political perspective then, is what Congress could do to deal with the chaos that would inevitably ensue.
The answer is complicated, as control of the Senate most likely hangs on two runoff elections in Georgia in January. Or if the Supreme Court did strike down the law with Democrats in control of both houses of Congress and the White House, they could use the decision as an excuse to push for broader health care reform. But if Republicans maintain control of the Senate, none of those fixes seem likely to happen, leaving the health care system in real jeopardy.
In other words, a world in which the entire ACA is overturned by the time the current Supreme Court term ends in June seems somewhat unlikely, but understanding the risks of that scenario is important.
About RWJF. Quick Links. Researchers provide an overview of how overturning the ACA would affect average, hypothetical individuals using realistic information on premiums, subsidies, and ACA program eligibility.
Moderate- and low-income families and those with health problems stand to lose the most. The Issue The U. Download brief PDF. Obamacare established public marketplaces for individuals and families to shop for insurance plans that are compliant with ACA regulations.
The exchanges also let citizens see if they qualify for federal subsidies that can help reduce health care costs. Twenty-eight states use federally run marketplaces, while 12 states use their own state-based marketplaces. Eleven states use either federally supported state marketplaces or marketplaces that are run by a partnership between the federal government and the state.
But those exchanges would likely cease to exist if Obamacare is repealed, according to Cori Uccello, a senior health fellow at the American Academy of Actuaries. Uccello said she is not sure what would happen to the state exchanges, but people who got their plans on the federal marketplace would almost certainly lose their coverage.
While data on how COVID has spread through schools that are reopened for in-person instruction are subject to uneven reporting , one independent analysis reports that there are more than 24, verified cases tied to K schools. Of the 20 million newly uninsured Americans, millions are parents who would not only have to worry about health risks to their loved ones but also unknown or unaffordable medical costs. If families become uninsured and need intensive care or treatment, they could be on the hook for tens of thousands of dollars, leading to medical debt or even bankruptcy.
If the ACA is repealed, millions of Americans would pay more for their prescription drugs, including for lifesaving drugs that treat COVID and conditions that place people at higher risk of the virus. Before the ACA closed the coverage gap, about 5 million Medicare enrollees fell into it. With nearly 9 in 10 older adults taking prescription drug medication—and 1 in 4 seniors already struggling to afford their medications—reopening the coverage gap would have devastating consequences.
Before the ACA, individual market plans were not required to cover prescription drugs. Without the ACA, insurers could exclude all drugs or entire classes of drugs, leaving some patients with high out-of-pocket costs and others unable to afford the treatments they need during the current public health crisis. Medicaid expansion narrowed racial gaps in coverage —which is particularly important as the pandemic continues to hit communities of color most harshly—and is critical for both preventive and curative care.
States such as Ohio, Pennsylvania, Michigan, West Virginia, California, and Louisiana continue to battle the pandemic, each with hundreds of thousands enrolled in Medicaid expansion.
The sudden elimination would be catastrophic for public health, likely preventing millions of newly uninsured people from accessing treatment, threatening their own well-being and compounding the spread of the virus. Furthermore, low-income families currently benefiting from Medicaid expansion would be at grave risk of financial catastrophe and more likely to take out debt in the event of a health emergency if they were to lose their coverage.
Due to systemic racism, sexism, and poverty, Black women and Latinas disproportionately rely upon the benefits the Medicaid program provides, including covering nearly half of all births in the United States.
Eliminating this safety net is particularly concerning given Black women were already facing a maternal health crisis before the COVID pandemic devastated their community. Additionally, ACA repeal would reverse the gains from Medicaid expansion on the employment of people with disabilities—which is typically abysmally low—and would harm a community that is already disproportionately poor.
Finally, research shows that Medicaid expansion has also enhanced public safety by helping low-income working-age adults transition from incarceration, saving communities tens of billions of dollars. Stripping coverage from more than 20 million Americans at any point in time would be terribly cruel, but to do so during a deadly pandemic would be catastrophic on individual, community, and national levels.
During this economic crisis and public health emergency, the president should be following the guidance of public health experts and trying to increase access to affordable health care. The Trump administration should use the energy and speed they are applying to this callous endeavor to slow the spread of the coronavirus and help all Americans gain health care coverage to protect them during this unprecedented time.
Maura Calsyn is the managing director of Health Policy at the Center. Colin Seeberger is a director of Media Relations at the Center.
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