Affordable Care Act met need, postponed rollback to 2020

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This year, Americans’ access to health care was in the spotlight like never before.

Since March, more than 250,000 people infected with the coronavirus have died and millions more have lost their health insurance in the economic crisis caused by the pandemic.

During the presidential campaign, President Donald Trump and President-elect Joe Biden have pledged a lot to tackle these health and economic issues, fighting over how best to provide Americans with access to health care. At the center of their two arguments remained a ten-year-old law: the Affordable Care Law – a landmark health care law that has shown its continued importance during this particularly difficult year.

Trump wanted to dismantle it, while constantly promising a replacement plan that never materialized, and Biden vowed to build on the current law in the hope of offering a public option.

“Health is the kitchen table issue for most Americans, both because of the cost and what it means to live without coverage,” said Leslie Dach, former senior advisor at the Department of Health and Human Rights. Social services under the Obama administration. .

“We are now at a time this year when people need ACA more than ever before, and years of studies have shown how its coverage positively impacts health, life expectancy and ability to recover. find a job, ”added Dach, the founder. of Protect Our Care, a liberal group dedicated to protecting the law. “And yet, for purely partisan or ideological reasons, people are trying to take it apart.

These efforts have not been particularly successful.

“A great safety net during the pandemic”

Just over 10 years after the law known as Obamacare was passed, landmark healthcare legislation has survived numerous attacks under the Trump administration and appears to be deeply entrenched in the healthcare system from the country. The effect he has had during that difficult year – whether in politics, politics or at the kitchen table – is hard to dispute.

Although it is currently unclear exactly how many people remain without health insurance due to the current economic crisis, between February and June, around 14.6 million people – workers and their dependents – were affected by job losses which also resulted in the loss of employees. health insurance, a Commonwealth Fund estimate found.

In states that have embraced the expansion of Medicaid, the Affordable Care Act has helped consolidate some of those losses, especially as the rollers for the public health insurance option for low-income people have exploded this year.

Other people have found options through the plans offered by the ACA or have received coverage from a spouse or parent, COBRA, short term health plans or just disappeared.

The exact number of people who lost insurance in 2020 will remain unknown until the end of next year. The Congressional Budget Office released a report in September on the number of uninsured people in 2019 – 30 million – and they estimated that number could increase by one million people due to the pandemic.

They concluded, however, that the situation could have been worse if it were not for the options offered by the ACA and the way the law expanded Medicaid.

“In many states, no matter your level of poverty or how much income you’ve lost, you may still not qualify for Medicaid until the ACA exists,” said Cynthia Cox, vice -President of the Kaiser Family Foundation director of its ACA program. “So the Medicaid program has been a great safety net during the pandemic and its economic turmoil and all that has happened as a result.”

The law also appeared to remain fairly durable, although it effectively lost the individual mandate, which required all Americans to purchase health insurance or face a costly tax penalty. Trump used a 2017 tax bill to impose an individual mandate violation penalty of $ 0.

The Supreme Court could still decide to strike down some or all of the law next year, but many believe that is unlikely after justices listened to oral argument earlier this month.

It looks like Trump will step down from office without keeping his promise to “repeal and replace” – or even just “repeal” – Obamacare.

The reason the law was impossible or extremely difficult to dismantle, according to many experts, is because it is deeply embedded in America’s healthcare system. So much so that it would be difficult for consumers and insurers to imagine the healthcare landscape after its demise.

“Everyone talks about Obamacare like it’s a thing, an object, like you can point to the Obamacare part of the federal government or the federal budget, but it’s not like that,” Chris Pope said, a senior researcher specializing in CBA and rights. reform at the Manhattan Institute, a conservative think tank. “The Affordable Care Act changed federal laws in 1,000 different places, many of which have since changed. There are new laws depending on it. So you can’t just undo it.

The law has also reached its peak this year since it was passed in 2010, with 55% of Americans saying they view ACA favorably, according to the Kaiser Family Foundation. Experts attribute growing favor to Trump’s threat to suppress him without a clear plan to replace him.

There is a very good chance that people who are not currently insured will be covered for free. But they should act quickly.

Cynthia Cox

Trump tried to undermine the law by slashing the marketing budget for open enrollment and outreach by 90%, according to the Kaiser Family Foundation.

Cox said many may not have known that they are currently eligible for health insurance through the ACA, or that they can currently purchase coverage until December 15.

“Four in 10 uninsured people are eligible for free coverage, either Medicaid or a zero premium bronze plan,” she said, referring to a plan offered by the ACA. “So there is a very good chance that people who are not currently insured will be covered for free. But they should act quickly. “

Is “Bidencare” next?

Biden said he has big plans to build on the law so others can access health care. However, it can be difficult for him to do much in Congress, as both houses face small margins both ways for party control.

While the former vice president has said he plans to roll out a public option he called “Bidencare,” few believe he will be able to convince Republicans to adhere to a plan like this. -the.

Rather, he’s more likely to try to undo some of the Trump administration’s efforts to undermine the ACA while also looking for ways to attract the dozen states that have refused to expand Medicaid.

The stalemate is primarily due to Republican-controlled state governments that have refused largely free federal funding to expand Medicaid on ideological grounds around tax spending and because of its connection to the Obama administration.

But Benjamin Sommers, professor of health policy and economics at Harvard TH Chan School of Public Health, said those states were forgoing an economic windfall offered by the federal government.

States didn’t have to cut any programs and saw huge economic benefits when they decided to expand, he concluded in a June analysis published in the New England Journal of Medicine.

“It’s a victory for the state budget and clearly for the patients,” he said. “And when you take it all together, what you can see is that Medicaid is not just a public health investment during a pandemic, but it’s also a form of stimulus for local and state economies.

As 12 states continue to reject the Medicaid expansion that would likely provide health insurance to 2 million people, voters in Missouri and Oklahoma – both considered conservative states – chose to take that option by vote. this year, appearing to prove that ACA items are universally popular.

Biden is expected to try to find ways to encourage the remaining 12 states to embark on an expansion, which would greatly benefit members of the working poor, but it could take some time.

The Pope said it was inevitable that states would end up signing. He noted that it took almost 20 years for all states to adopt Medicaid after Lyndon B. Johnson signed it as part of his “war on poverty.”

“From the state’s perspective, it’s a pretty good deal,” Pope said. “They get $ 9 from the federal government for every dollar they spend themselves. So I think everyone is somehow assuming that they will eventually accept it, but the question is, how much of the Democratic House, the Biden administration, and an evenly divided Senate will put extra money on. table to advance the needle in that direction. ? “

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