Shefali Luthra, Kaiser Health News
Endorsing his former vp, Joe Biden, to win the White House, former President Barack Obama sought to distinction the 2020 platforms of Democrats and Republicans on a important plank: their stance on the Affordable Care Act. It’s a distinction, he argued, that has assumed newfound urgency.
“The Republicans occupying the White House and running the Senate … have shown themselves willing to cut millions off their health insurance and eliminate preexisting condition protections for millions more, even in the middle of this public health crisis,” Obama stated.
Obama was referring to a few GOP insurance policies, the previous president’s senior adviser Eric Schultz informed KHN. The first: a pending Supreme Court case, Texas v. Azar, during which the Trump administration has argued the 2010 well being legislation needs to be struck down. Schultz additionally highlighted the White House’s refusal to supply a particular open enrollment interval for the ACA well being exchanges within the midst of the coronavirus pandemic.
We’ve previously checked claims about President Donald Trump’s stance on the legislation’s preexisting situation protections — arguably its hottest part ― and his place on the Texas v. Azar lawsuit.
But COVID-19 provides new relevance, due to each the virus’s devastating well being implications and bludgeoning impression on the American economic system. Indeed, the Trump administration’s dealing with of the virus disaster is shaping as much as be a defining subject within the run-up to November. Meanwhile, Biden made the well being care legislation a signature part of his presidential platform and has been a vocal critic of the administration’s pandemic response.
With that in thoughts, we determined to take one other look.
The Republican Agenda
Obama is appropriate: The Republican Party has opposed the ACA for years. In 2016, then-candidate Trump campaigned on its repeal. Since then, the White House and congressional Republicans have pursued an agenda that will dismantle the legislation’s preexisting situation protections. Republicans haven’t united behind another plan, both.
First: the lawsuit. Texas v. Azar stems from the 2017 Tax Cuts and Jobs Act. That measure took the tooth out of the well being legislation’s particular person mandate, which required that every one Americans have medical insurance or pay a penalty. The tax legislation, pushed by Republicans and signed by Trump, set that penalty to $zero.
A set of Republican states’ attorneys basic now argue that, with out the penalty, the remainder of the well being legislation doesn’t work and needs to be struck down.
Killing the ACA would remove the stipulation that insurance policy can not cost individuals extra if they’ve a preexisting situation, do away with the subsidies it offers for individuals to purchase insurance coverage on the exchanges and intestine the Medicaid growth that, in six years, directly extended coverage to greater than 13 million individuals. The Supreme Court has agreed to listen to the case, though it gained’t rule till after the November election.
The Trump administration, whereas technically within the place that will defend the legislation in court docket, has declined to assist it — a transfer authorized consultants say is nearly unprecedented. In truth, the administration has even sided with the states arguing that it needs to be struck down. Neither the White House nor Senate Republicans have put forth a substitute invoice that will keep the ACA’s protections within the occasion the excessive court docket guidelines in opposition to the legislation.
We requested the White House if the administration had modified its stance within the wake of the pandemic. Trump’s employees redirected us to the Department of Justice, the federal authorities’s authorized arm. The DOJ didn’t reply to emailed requests for remark. As not too long ago because the end of March, although, Trump informed reporters he nonetheless wished the legislation “terminated.”
Senate Democrats have pushed the administration to alter its place on the lawsuit. But Republicans, who maintain the Senate majority, have been silent, a place that hasn’t modified even since COVID-19 successfully shut down massive swaths of the nation.
In some methods, the Republican stance isn’t vital, argued Thomas Miller, a resident fellow on the American Enterprise Institute, a public coverage suppose tank. It’s arduous to think about the Supreme Court voting to do away with the well being legislation, particularly within the midst of COVID-19, he stated.
Still, that doesn’t change the info of what Trump is arguing.
And the lawsuit can be just one a part of the equation. Another, is healthcare.gov.
Americans who’ve misplaced their jobs ― and, typically, the insurance coverage that got here with it — are eligible to purchase insurance coverage on the federal trade, since job loss is a“qualifying life event” that will get you particular entry. Those who in any other case lack protection would usually have to attend till the common open enrollment interval, which takes place on the finish of the yr. But the specter of COVID-19 has modified the chance for a lot of of those potential customers.
In response, 11 states have independently reopened their state-run well being exchanges for a particular sign-up interval. But the administration has declined to take such steps for the nationwide market.
“If you have been uninsured and picked up your newspaper, or turned on your news and realized your health was in much greater risk than you had anticipated, and would like to rush and get health insurance in case you end up on a ventilator ― you’re out of luck,” stated Linda Blumberg, a well being coverage fellow on the Urban Institute, a nonprofit analysis group.
Even earlier than coronavirus, the institute estimated that 32 million Americans have been uninsured. About 20 million of them may gain advantage from a particular enrollment interval, Blumberg stated. Without insurance coverage, coronavirus remedy poses not only a well being danger, but in addition a monetary one.
The Trump administration has stated it will pay hospitals directly, out of a pool of $100 billion, to cowl the price of treating uninsured individuals with COVD-19. After treating sufferers, hospitals would receives a commission on the Medicare price.
But the administration’s coverage extends solely to protecting COVID-19 remedy. Uninsured individuals with underlying power circumstances don’t have a option to pay for well being care, famous Robert Berenson, one other Urban Institute fellow. If left untreated, these power illnesses make COVID-19 much more harmful than it could be for somebody in a position to get preventive remedy earlier on.
Coronavirus And The ACA
President Trump’s stance raises one other query, consultants famous. Without the ACA, what sort of impression would COVID-19 have?
Even with the heath legislation intact, many Americans gained’t have the ability to discover inexpensive medical insurance. That notably applies to individuals who can’t afford the premiums on the person market, don’t qualify for federal subsidies or stay in one of many 14 states that didn’t decide into the ACA’s Medicaid growth provision.
And the ACA is nowhere close to adequate by itself, Miller famous. Having insurance coverage is a part of the image, however it doesn’t assure entry to testing or hospital will have the ability to deal with you. “On the margins, it does help a little bit to have insurance coverage, but the problem is so much larger than that,” Miller argued.
Still, with out the well being legislation, the virus’s impression can be “catastrophic,” stated Jonathan Oberlander, a well being coverage professor on the University of North Carolina-Chapel Hill.
Striking the person market and Medicaid growth would go away virtually one other 20 million individuals uninsured — “at risk,” stated Larry Levitt, a vp on the Kaiser Family Foundation. (KHN is an editorially unbiased program of the muse.)
Without the ACA, COVID-19 might be thought-about a preexisting situation. Insurance corporations may cost extra to cowl individuals who have beforehand contracted the virus (assuming, after all, these individuals can get examined and recorded as having had COVID-19). Plus, rising proof suggests extreme circumstances of COVID-19 could go away lingering well being penalties, that even after restoration would require ongoing medical care, Levitt stated.
“The ACA’s consumer protections ensure that persons with COVID-19 can obtain insurance without fear of being turned away or charged exorbitant premiums because of their preexisting condition,” Oberlander stated.
The well being legislation additionally imposed strict laws over what insurance coverage should cowl. Without these laws, plans may ― and certain would — revert to skimpier protection, Blumberg stated.
That, she stated, means plans that maybe don’t cowl ventilators or branded medicines, or that cap what number of days of hospital care they’ll cowl, or that require individuals to pay rather more out-of-pocket.
“Insurers, given the legal ability to do it, would limit their legal liability and protect themselves from high claims,” she stated. “They did it before and will do it again.”
Our Ruling
Obama accused the Trump administration and Senate Republicans of being “willing to cut millions off their health insurance and eliminate preexisting condition protections for millions more, even in the middle of this public health crisis.”
Evidence signifies that that is an apt characterization. None have put forth a plan that will keep protection or client protections ― insurance policies that profit thousands and thousands of Americans — if the Supreme Court guidelines in opposition to the ACA. And as Obama asserts, placing down the legislation with out an equal substitute might be devastating, particularly throughout the COVID-19 pandemic. We price this declare True.
Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially unbiased program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.