If ACA is unraveled, consequences will be devastating

The Affordable Care Act, often called Obamacare, and the associated Health Care and Education Reconciliation Act remain deeply divisive.

In 2010, phrases such as “death panels” or “the government taking away your right to keep your insurance” proved effective. The ACA’s popularity was about 35 percent, according to the Pew Research Center. However, by 2017 as the provisions phased in, roughly 54 percent of the U.S. population viewed the ACA as positive, and Kaiser Family Foundation survey results in 2020 suggest its popularity has risen even further.

Republicans have vowed to repeal — and later to repeal and replace — the ACA from its inception. Consequently, the ACA has been repeatedly challenged in the courts over its individual mandate and as an infringement on the sovereign authority of states. These challenges resulted in the National Federation of Independent Business v. Sebelius case brought before the Supreme Court in 2012. Only due to the interpretation that Congress has the power to tax, and the individual mandate penalty was, in fact, a tax, did the court rule 5-4 to preserve the ACA.

With the passage of the 2017 Tax Cuts and Jobs Act, the elimination of a penalty for not obtaining health insurance effectively gutted the individual mandate, thus removing a key element supporting the legality of the ACA. Republican states renewed efforts to challenge the ACA.

Why does this matter? The

ACA was a comprehensive piece of legislation because of the complexities of the U.S. health care system. Its provisions have posibe tively impacted millions of Americans. The ACA helped control Medicare cost-growth by shifting emphasis away from specialists and volume-driven procedures, and toward wellness and more comprehensive care coordination. This helped reduce out-ofpocket expenses for seniors.

It covered young adults up to age 26 on parental commercial health plans, protected coverage for an estimated 54 million Americans with pre-existing conditions, enforced plan coverage across state lines, facilitated Medicaid expansion programs, funded health care provider training programs and constructed the ACA legal framework to facilitate lower-priced pharmaceuticals via generic biologic substitutes.

In March, the Supreme Court accepted an appeal by a number of state attorneys general to decide if the ACA should remain in place. The court also accepted a cross-appeal by Texas and several other states asking the entire law struck down.

If the ACA is struck down, the implications are enormous.

Republicans have yet to produce any replacement as comprehensive or cost-effective, rendering President Donald Trump’s recent executive order that “covers” pre-existing conditions merely symbolic. An estimated 10 million Americans have lost health insurance because of the contraction of the economy during the pandemic, with estimates of 40 million uninsured by the end of 2020.

That brings us back to Texas. According to the Census Bureau’s American Community Survey in 2018, 13.2 million people in Texas were covered by employer-based plans. Medicare covered more than 2.9 million, and almost 490,000were covered byamilitary plan. Roughly 1.7 million Texans bought nongroup coverage plans, and more than 4.7 million were covered by Medicaid. With Texas’ ardent stance to not expand Medicaid, this leaves roughly 5 million uninsured, the highest percentage of any state.

But the real impacts of the COVID-19 recession are yet to be felt. Job losses are often accompanied by a loss of employer-based health plans.

If the ACA is struck down, more Texans will lose coverage. They may be younger than 26 now and covered on a parental health plan; or they may lose health insurance and be denied future coverage because of a pre-existing condition; or they may lose coverage for mental health services; or they may experience the elimination of annual or lifetime benefit caps.

The potential unwinding of the ACA is going to touch many families in Texas. How is Texas’ leadership planning to deal with this?