If the ACA is struck down with no replacement, then what?

When Yuriana Jaramillo, 32, of Salinas, Calif., left her job in 2013 to stay home after having her first child, it was a risky move.

Quitting her job meant one less paycheck in what had been a two-income household. It also left Jaramillo without the health insurance coverage she had been receiving through her employer. Over the next 18 months, Jaramillo applied for insurance through the private market but was denied coverage. A prior knee injury was flagged as a pre-existing health condition, making her ineligible.

“They told me I was high risk,” Jaramillo said she was told by insurers. “They said that maybe I may need to have surgery, but the doctor didn’t even mention that—they were just making assumptions.”

Jaramillo’s luck changed in January 2014 when Affordable Care Act rules went into effect that banned insurers from denying coverage due to pre-existing conditions. That year, Jaramillo purchased a qualified heath plan through the Covered California health insurance marketplace with the help of federal and state subsidies.

Jaramillo’s story is not dramatic, but it’s an example of the real-world impact of what has arguably been the most contentious political debate of the past decade—healthcare in America.

The passage of the Affordable Care Act in 2010 has been followed by a seemingly nonstop series of legal and legislative fights over its existence that are expected to carry on into the foreseeable future.

And while we knew the party that had passed the ACA was invested in keeping uninsured rates low, the GOP and this administration express reservations about “forcing” people to have coverage and don’t seem to talk about what would happen to the uninsured.

At its core, the ACA debate surrounds government’s role in healthcare. There is no doubt that the federal government’s market influence could dramatically help achieve better quality and value in healthcare.

But there are also questions over government’s responsibility to protect the interests of its people. Few would argue that your health and that of your loved ones is of greatest interest to most.

Still humans are human and when faced with the potential to make millions or even billions, many will choose to do so even if that means hurting others. And that’s what makes it difficult to let healthcare fall to market forces.

When allowed, insurance companies will cherry-pick the youngest, healthiest members and still make money off them through very low premiums, while older, sick people would face potentially unaffordable premiums.

Market forces can’t be trusted to do what’s right when people’s lives are in danger.

Trickle-down theories be damned. Look at what happened after Trump’s recent tax breaks to large corporations.

For decades in the U.S., income inequality has become so vast that it’s virtually unheard of for someone to rise from poverty or the middle class. What you’re dealt when you’re born is what you live with for most of your life.

So at extreme moments of pain and despair, in the worst case scenario of your health, if you don’t have the money to cover it yourself, or an employer generous enough to help pay for your medical bills, you’re out of luck.

Is that the kind of community we want? Especially when facing a pandemic.

This is not a plea to save the Affordable Care Act. Our coverage marking the anniversary asks whether it should be repaired or replaced.

What I am asking is what happens if the ACA is repealed and there’s nothing to replace it.

The last time I was able to ask a federal official whether there was a replacement plan was August 2019 and I was told one was coming soon. Seven months and one pandemic later, it’s states and providers that are figuring out ways to keep the uninsured healthy.

My hope is that ultimately, government and the private sector come together to address the concerns over costs and make it easier for people to access care when they’re healthy rather than wait for a crisis. ●