Affordable Care Act returns to top court
Stakes high as decision could strike down law
When the Supreme Court hears a case Tuesday that could abolish the Affordable Care Act, the stakes will be higher than ever, coming amid a historic health and economic crisis that has deprived millions of Americans of insurance and cast a neon light on health care’s importance.
A decision this term to strike down the entire ACA— unlike when justices upheld the law on different grounds in 2012 and 2015 — would upend the health-care system in ways that touch most people in the United States.
If the high court, with a newly strengthened conservative majority, were to overturn the law following this week’s oral arguments, health insurance would collapse for at least 23 million Americans. Nearly 11 million would lose coverage through marketplaces created under the ACA to sell private health plans, usually with federal subsidies, to people who cannot get affordable benefits through a job. And about 12 million, insured because of Medicaid expansions in all but a dozen states, could find that coverage disappear.
According to health policy specialists, the consequences would ripple significantly beyond those losing their insurance outright. Flu shots, cancer screenings and other preventive care — including the cost of administering a coronavirus vaccine once it exists — would no longer be free of charge. Older customers would pay higher insurance rates. Young adults no longer could stay on their parent’s insurance policies through their mid-20s. And most health plans no longer would be required to cover as many types of care.
“Overturning the ACA would affect almost everyone, one way of another,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, a nonpartisan health policy group. It would “put the health system into chaos and the political system into chaos as well,” he said.
Georges Benjamin, executive director of the American Public Health Association, noted that the law’s end would take money away from community health centers, the Centers for Disease Control and Prevention and already strained rural hospitals.
Such far-flung effects would materialize no matter when the high court decided the law was unconstitutional. The 2,000-page law adopted in 2010 by a Democratic Congress was a main domestic achievement of the Obama presidency.
In the decade since, the statute’s many moving parts have become entrenched in the habits and expectations of insurance companies, hospitals, doctors’ offices and state governments — not to mention the consumers of medical care.
But the renewed possibility that the high court could find the sprawling law unconstitutional carries particular intensity at this moment, months into the coronavirus pandemic, which has sickened more than 9.5 million people in the United States and caused more than 234,000 deaths.
For those who have been infected and are aware of the court case, one of the greatest fears involves a part of the law that consistently has ranked as the most popular in years of public opinion polling: protections for people with preexisting medical conditions.
The protections forbid insurers to charge such customers higher prices, to refuse to cover them for care associated with their condition, or to refuse to sell them a health plan at all.
The court’s likelihood of striking down the law this time, ending insurance protections for people with COVID-19 or other medical conditions, is a matter of debate. Since early 2018, when a group of Republican attorneys general launched the lawsuit that has evolved into the Supreme Court case, health law scholars who support and oppose the ACA have uniformly contended that the suit’s legal arguments are weak.