Millions of people would lose access to affordable health care if the 2010 law is repealed, and countless others would be affected.
President Trump doubled down last week on seeing the demise of the landmark healthcare law that gave coverage to millions of Americans—even as the country navigates a devastating global health crisis and historic job losses that have resulted in millions losing their employer-sponsored health coverage.
Responding to a question last Wednesday about whether or not his administration would continue to support a Republican-led lawsuit to repeal the Affordable Care Act, Trump told reporters: “Obamacare is a disaster … It was a disaster under President Obama, and it’s very bad health care. What we want to do is terminate it and give great health care.”
Nearly 20 million people would lose access to affordable health care if the 2010 law is repealed, and countless others would be affected by increased prescription costs, the loss of protections for pre-existing conditions, and more.
Despite Trump’s assertions that he plans to replace the Affordable Care Act, his administration has yet to release a plan to address comprehensive healthcare reform.
In March, the Supreme Court agreed to hear a lawsuit led by 18 Republican state attorneys to strike down the ACA in its entirety. May 6—the day Trump reaffirmed his administration’s support of a repeal—was the last day the Department of Justice could reverse its position in the suit. Two days earlier, according to CNN, U.S. Attorney General William Barr had pushed for the White House to preserve parts of the 2010 law instead of fighting to eliminate it completely.
Because the federal government has declined to defend the ACA in legal challenges, a coalition of Democratic attorneys general, led by California’s Xavier Becerra, has stepped up and will defend the lawsuit when the Court hears the case in its next term, starting in October.
“It’s unconscionable that the Trump Administration continues its attack on healthcare, just when many Americans across the country need it most,” Becerra said in a statement released the same day the president shared his disdain for the ACA. “A global pandemic is the time to wake up and protect the lives of our loved ones, yet all we see from the President’s team is repeal without replace.”
In a brief filed with the Supreme Court last week, Becerra and his fellow petitioners write that the ACA has been “instrumental” in the United States’ response to the coronavirus pandemic. “Its ‘essential health benefits’ provision is requiring insurers to cover the costs of diagnosis and treatment—and will require them to cover the cost of an approved vaccine,” the brief states. “And the ACA is allowing Americans who have lost their jobs and their employer based health insurance to purchase coverage through the Exchanges and to obtain subsidies for that coverage.”
More than 33 million Americans have lost their jobs during the coronavirus, and nearly 13 million of them have lost their employer-sponsored healthcare, according to estimates from the nonpartisan Economic Policy Institute. If unemployment hits 20%—it’s currently at 14.7%— between 25-43 million people could lose their employer-sponsored coverage during the pandemic, according to a report from the Urban Institute.
For these millions of laid-off workers, the ACA and Medicaid are currently their two most affordable paths to getting coverage. Using its more conservative estimate of 25 million people losing their employer-sponsored coverage, the Urban Institute projects about 12 million (47%) of them would qualify for Medicaid, the nation’s public insurance program for people with limited income and resources. Another six million (25%) would gain coverage through the ACA marketplace, while seven million (29%) would become completely uninsured.
But if the ACA were repealed, that number would skyrocket. Not only would those who have coverage through the marketplace lose their plans, but those who qualify for Medicaid would be affected too. Under the ACA, the income limit for Medicaid was lowered, and 36 states expanded their program to cover more low-income adults. If the ACA were no longer on the books, millions of individuals would no longer qualify for Medicaid coverage and would be left without affordable options.
Millions of others would be affected as well, as Arizona Rep. Tom O’Halleran pointed out last week. O’Halleran called the lawsuit “a disaster for more than 130 million people with pre-existing conditions,” as well as “seniors on prescription drugs, and young adults on their parents’ insurance plans.”
Healthcare advocates also blasted the lawsuit and Trump’s support of it during the pandemic.
“As tens of thousands of Americans die and more become infected with the coronavirus, President Trump is standing by his position to destroy the health care law and rip coverage from 20 million Americans,” Brad Woodhouse, executive director of Protect Our Care, said in a statement. “Nothing, not even a global pandemic in which the United States leads the world in deaths and infections, is enough to deter this president from trying to take away people’s health care when they need it most. It’s downright cruel.”
Some GOP lawmakers appeared unnerved by the prospect of the Trump administration’s efforts to repeal the law, rather than defend it.
“The ACA remains the law of the land, and it is the Department of Justice’s duty to defend it,” said Sen. Susan Collins (R-ME). “That is especially true during the current public health crisis our country is facing due to COVID-19.”
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She is among those urging the administration not to get rid of the law, but instead make broader use of it to cover uninsured people during the pandemic.
Meanwhile, Republican Sen. Lamar Alexander of Tennessee, who plans to retire this year, told Meet the Press anchor Chuck Todd on Sunday that he was disappointed that President Trump decided to continue with the lawsuit.
“I thought the Justice Department argument was really flimsy,” Alexander said. “What they’re arguing is that when we voted to get rid of the individual mandate, we voted to get rid of Obamacare. I don’t know one single senator that thought that.”
It’s unclear whether the Supreme Court will hear oral arguments before the November election. The GOP-led states contend that because Congress repealed an ACA tax penalty, the law’s requirement for individuals to carry health insurance is unconstitutional. If the insurance mandate is unconstitutional, their argument goes, then the rest of the law must collapse like a house of cards.
If the court sides with Trump, it could leave tens of millions of Americans uninsured as a global pandemic with no end in sight rages on.
Additional reporting by the Associated Press.