Philly.com
December 20, 2018
Sometimes Kate
Beschen lies awake at night, thinking about what she’d do if the health
insurance she buys through the Affordable Care Act marketplace disappeared.
The 45-year-old
Philadelphian has a chronic form of leukemia that she’d never be able to afford
to treat on an adjunct professor’s income without insurance.
The occasional
sleepless nights began after President Trump, who vowed during his campaign to
repeal the health law, won the 2016 election.
But what was once a
hypothetical monster under her bed is starting to feel more real.
In early December,
a Texas judge issued a judgment that the Affordable Care Act is
unconstitutional and should be eliminated, a move that would have a seismic
effect extending to all kinds of insured consumers.
Millions of people
who gained insurance through the ACA marketplaces and expanded Medicaid
eligibility would lose coverage. Rules that require insurance plans, including
those offered by employers, to guarantee coverage of pre-existing conditions
would go away. Adult children would no longer be able to stay on their parents’
health plans until age 26.
“This would affect
nearly every American in some shape or form,” said Katie Keith, an adjunct law
professor at Georgetown University.
The Texas-based
lawsuit, brought by 20 Republican attorneys general or governors, faces certain
appeal, possibly all the way to the U.S. Supreme Court.
In the meantime,
the ACA remains intact. The federal government has said it will continue to
enforce the law 2018-- including health coverage for the millions of people who
bought insurance through the ACA marketplace for 2019 -- until a final ruling.
That’s good news
for people like Daisy Fried, 51, of Philadelphia, who was able to sign up for
health insurance for the first time in years when the ACA marketplaces opened
in 2013.
A poet and
part-time professor, Fried occasionally had access to health insurance through
an employer, but mostly she just counted on staying healthy.
“I hit my 40s and
was like, you know, this is getting a little scary,” said Fried, who expects to
pay $225 a month for an ACA marketplace plan in 2019.
She never worried
too much about being uninsured, but getting covered “made me feel more secure,”
she said, especially as unanticipated health needs become more likely with age.
Whether Fried
continues to have access to her health plan will depend on what happens
ultimately with the Texas lawsuit.
The lawsuit arose
after Congress decided to stop penalizing people who don’t buy health
insurance, beginning in 2019. Under the ACA, most people were required to buy
insurance or pay a tax penalty, a rule that, though unpopular, ensured enough
healthy people were buying insurance to allow insurers to cover unhealthy
members.
In an earlier
lawsuit against the ACA, the Supreme Court ruled that the law was
constitutional because it wasn’t forcing people to buy insurance. Rather, it
was taxing those who didn’t, which Congress is allowed to do.
The Texas lawsuit
alleges that with the tax reduced to zero, the individual mandate is
unconstitutional and the law should be eliminated.
The Justice Department
agreed that without the individual mandate, new rules for private insurers --
such as requiring coverage for pre-existing conditions -- should be revoked,
but said the rest of the law should remain.
The case could take
years to work through the legal system, and though ACA insurance remains
available, uncertainty about the law’s future could do its own damage.
“It could have a
very serious effect, even if it has no real legal effect at this point,” said
Timothy Jost, a law professor at Washington and Lee University School of Law,
during a call with reporters organized by the Commonwealth Fund.
Insurers will need
to decide in the spring, before the lawsuit is resolved, whether to continue
selling ACA plans in 2020 and how much to charge.
People confused over
the status of their plans could fail to pay their first month’s premium, which
is required for coverage to take effect.
Analysts speculated
whether the judge’s order, which came out the night before the final day of the
ACA marketplace’s open enrollment period, would deter people from signing up at
the last minute.
By preliminary
counts, 8.8 million people in the 39 states that use the federal healthcare.gov marketplace
bought plans for 2019, up from 8.7 million the year before.
In Pennsylvania,
396,725 people bought ACA plans for 2019, an increase of about 7,600 people
from the year before. An additional 4,000 New Jersey residents signed up, for
total enrollment of 278,881 in that state.
“There’s this
shroud of uncertainty that’s going to hang over everything,” Keith said. “We
sort of just got to this place where the marketplace was stable.”
Legal scholars are
skeptical that a higher court would uphold the Texas judge’s broad decision,
but for people like Beschen, who are counting on insurance coverage made
possible by the law, the threat is terrifying.
“There’s always the
worst-case scenario and getting carried away. I’m not the person who thinks
that way about life -- full of fear about what’s going to happen. But this is
an actual, real, practical fear,” she said.
Every three months
Beschen pays $60 for blood testing to monitor her slow-growing blood cancer.
Her monthly premium next year will be $70 because she qualifies for an
income-based tax subsidy.
Without the ACA,
Beschen could be denied coverage because of her pre-existing condition or
charged an exorbitant -- and out-of-reach -- amount.
Eventually she’ll
need chemotherapy, which would be unaffordable without insurance, she said.
She has looked into
whether she could move to Canada or another country with universal health care.
Beschen thought she
always would live in the country where she raised her own family, but she said
she may not have a choice. She can’t afford to live without health insurance.
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