By Julie Rovner December 16,
2019
Any day
now, the 5th Circuit Court of Appeals in New Orleans could rule the entire
Affordable Care Act unconstitutional.
At
least it seemed that two of the three appeals court judges were leaning that way during
oral arguments in the case, State of Texas v. USA,
in July.
Trump
administration health officials have said they will continue to enforce the
health law pending a final ruling from the Supreme Court. But that is not a
guarantee that President Donald Trump won’t change his mind. That’s what he did in 2017 in
canceling some payments to health insurers.
There’s
no doubt that invalidating the ACA in whole or in large part would have a
dramatic effect on the nation’s health system ― and not just for those 20
million or so Americans whose coverage directly flows from the law.
“Billions
of dollars of private and public investment ― impacting every corner of the
American health system ― have been made based on the existence of the ACA,”
said a brief filed by a bipartisan group
of health policy experts. Declaring the law null and void “would
upend all of those settled expectations and throw healthcare markets, and 1/5
of the economy, into chaos,” they wrote.
And
with health care continuing to be a top issue in the presidential campaign,
both Democrats and Republicans could find themselves scrambling for a fast
stopgap solution if the law were to suddenly go away.
First,
Some Background
At
issue in the ACA case is whether the language in the 2017 GOP tax bill reducing
to zero the tax penalty imposed for failing to have health insurance should
render the rest of the law invalid.
A group
of Republican state attorneys general and governors say it should. They argued
that without the tax, the Supreme Court’s justification for upholding the law
in 2012 no longer exists and so the law is now unconstitutional. U.S. District
Judge Reed O’Connor agreed with them last
December.
Supporters
of the law ― including not just Democratic attorneys general, but also the
Democratic-led U.S. House ― and bipartisan groups of legal and health policy
scholars say that’s just nonsense, that the law not only can function without
the individual mandate penalty but is functioning now.
What
would go away ― meaning which provisions consumers have become accustomed to ―
if the law is eventually struck down? Let’s take a look.
Insurance
Protections
Most
people think the health law directly affects only those Americans who purchase
their own insurance through the exchanges the law created (and who get subsidies
if their incomes are between 100% and 400% of the poverty level). That’s about
10 million to 12 million households.
But
many of the insurance protections in the law also protect those who have
insurance through their jobs. These provisions include allowing adult children
to stay on their parents’ health plans and requiring that insurers cover people
who have preexisting health conditions at no additional charge to those
patients. The law also requires that ACA-compliant policies provide preventive
care with no out-of-pocket cost, and bans annual and lifetime insurance
coverage limits.
It also
limits insurers’ amounts of profit
and administrative expenses. That makes for a lot of chaos right
there should the entire law disappear. But there is more.
Medicare
And Medicaid
Most
people with a passing familiarity with the health law know it expanded the
Medicaid program for those with incomes up to 138% of the poverty level (at
least in states that opted into the program).
The law
also made big changes to the Medicare program, including closing the notorious
“doughnut hole” that left some seniors with big drug bills despite having insurance.
The ACA also extended coverage of more preventive benefits for people with
Medicare coverage.
Generic
Biologics
An
important, though frequently overlooked, portion of the health law created the
first legal framework and regulatory pathway for copies of expensive, already
FDA-approved biologic drugs, called biosimilars, to reach the market. Biologic
drugs are among the most expensive medications and treat life-threatening
ailments such as cancer, rheumatoid arthritis and macular degeneration. It is
unclear what would happen to the stream of biosimilars already approved if the
law is struck down ― will their approvals be revoked? What about medications
currently in the approval pipeline?
Funding
For The Indian Health Service And Training More Health Professionals
Among
other little-known features of the ACA is a provision that permanently
authorized the U.S. Indian Health Service, which provides health coverage for
more than 2.5 million American Indians and
Alaska Natives. An overturn of the law could leave in doubt the
legality of some of the program’s operations.
Here’s
one more provision you may not have thought about. On the theory that if more
people have health insurance more people will seek medical care, the ACA has an
entire section devoted to increasing the supply of not just physicians, but
nurses, therapists, dentists and community health centers. Many of these
training programs could founder if the ACA is overturned.
And
those now-ubiquitous calorie counts on
restaurant menus? Those are there because of the ACA. Some people may not be
sad to see those go away. But if the ACA is invalidated, the health system will
likely change in ways that no one can predict.
HealthBent,
a regular feature of Kaiser Health News, offers insight and analysis of
policies and politics from KHN’s chief Washington correspondent, Julie Rovner,
who has covered health care for more than 30 years.
No comments:
Post a Comment