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On June 25th, as confirmed cases of coronavirus (COVID-19) hit disturbing global highs, 17 states led by Texas submitted an 82-page brief to the U.S. Supreme Court challenging the validity of the Affordable Care Act (also known as Obamacare).
The lawsuit argues that Congress never intended for the act to be enforceable without the “individual mandate” in place that was repealed in 2012. They say the repeal, which went into effect in January 2019, invalidates the remaining components.
If such an assumption holds up under legal scrutiny, it would wreak havoc on the entire healthcare system at a time when the country is fighting its most deadly public health disaster in modern history.
What would happen if the lawsuit prevails? The individual insurance marketplaces would dissolve just as millions of Americans have lost insurance due to pandemic-related unemployment, protections for people with pre-existing conditions and premium subsidies for low-income earners would be lost, and national public health initiatives that “promote public health, care quality, and delivery system reforms” would be gutted, according to the Kaiser Family Foundation.
“It is never acceptable to deny health care to Americans who need it, but it is especially egregious to do so in the middle of a pandemic,” New York Attorney General Letitia James tweeted.
She was arguing against another of Trump’s recent attacks on the ACA: separate but significant revisions that encourage health care discrimination on the basis of gender and English language proficiency.
Conservatives, including Trump administration deputy press secretary Judd Deere, argue that the ACA “limits choice, forces Americans to purchase unaffordable plans, and restricts patients with high-risk preexisting conditions from accessing the doctors and hospitals they need,” according to USA Today’s reporting. Supporters of the ACA essentially argue the opposite.
Despite strong criticism of the decade-old law from conservatives, two prior legal attacks have proved unsuccessful, and despite years of “repeal and replace” rhetoric, no Republican replacement has materialized — even when Republicans controlled both houses of Congress.
What is clear is that healthcare providers, insurers, and many patients benefit from the system as it stands, and a repeal would send shockwaves through every corner of it. Obamacare provided 130 million Americans with pre-existing conditions protection from access restrictions, while the number of uninsured Black Americans dropped by a third under it.
Oral arguments are expected to begin in November after the presidential election. The high court’s timing means that health care will be a crucial aspect of the election; a Republican vote could mean a loss of healthcare for newly-unemployed families whose only option for coverage right now is the ACA’s marketplaces.
House Speaker Nancy Pelosi had this to say the night of the brief’s filing: “...[this is] an act of unfathomable cruelty. If President Trump gets his way 130 million Americans with pre-existing conditions will lose the A.C.A.’s lifesaving protections and 23 million Americans will lose their health coverage entirely,” the New York Times reported.