Editorial: New challenge to the ACA

Health insurance coverage for tens of millions of Americans and hundreds of thousands of Minnesotans could be wiped away pending the outcome of a legal case heard by a federal appeals court on July 9.
A total of 18 Republican-led states are working closely with the Trump administration in hopes of overturning the Affordable Care Act. If the GOP attorneys general and the Trump administration have their way, it will have major implications for millions of Americans. Approximately 20 million Americans gained affordable healthcare insurance coverage as a result of the ACA, with about three-quarters of the gain coming from the expansion of the federal Medicaid program. Subsidies for many of those who didn’t qualify for Medicaid (due to higher income), helped several more million Americans pay for private insurance.
For those 20 million Americans, health insurance coverage would mostly be wiped away should the GOP and the Trump administration win their case in court.
Many more Americans would be affected in other ways. The ACA also requires insurance companies to cover pre-existing conditions, eliminates co-pays for many preventative medical services, and allows young people to remain on their parents’ insurance plan until age 26.
All of these provisions could well be eliminated depending on the outcome of the case. The Republican effort to kill the Affordable Care Act passed its first legal hurdle earlier this year when a federal judge in Texas ruled that the ACA’s requirement to purchase health insurance, known as the individual mandate, is unconstitutional.
The Supreme Court ruled 5-4 in 2012 that the individual mandate was constitutional because Congress imposed a fine for those who failed to purchase insurance. Chief Justice John Roberts determined that the fine was really a tax and since Congress is specifically authorized to levy taxes, the ACA could stand. But the latest GOP tax cut, passed in 2017, eliminated the tax for non-compliance with the insurance mandate, and the Texas judge said if there’s no tax associated with the mandate, it’s unconstitutional. If the mandate must go, the entire law should be struck down, Republicans argue.
The recent appeals court panel appeared open to the argument, which led many to believe they could strike down the ACA later this year. If so, the case is almost certain to go to the Supreme Court, possibly as early as late this year or early in 2020.
The impact of the case, if successful, could well be devastating to the millions of Americans who rely on the ACA. While far from perfect, the ACA managed to cut the number of uninsured Americans nearly in half within just a few years. Eliminating the ACA would send the numbers of uninsured in the U.S. skyrocketing and would, once again, allow insurance companies to deny coverage to people with pre-existing conditions. While the Trump administration is eager to undo one of the key legacies of the Obama administration, it has no actual replacement should the law be swept away by the courts. The result, as is usual with this administration, would be chaos.
The political implications are many. The ACA has grown significantly more popular in recent years, which means the GOP could well pay a price at the polls for taking affordable health insurance away from tens of millions of Americans.
It could also play a role in the ongoing debate within the Democratic Party, over how to advance health care access for more Americans. Presidential contenders like Joe Biden, Pete Buttigieg, and Amy Klobuchar say they want to build on the ACA, as opposed to adopting more inclusive programs, such Medicare-for-All, backed by Bernie Sanders and Elizabeth Warren.
If the ACA is struck down, there’s nothing left to improve. It will, if anything, strengthen the argument for single-payer options, which are clearly constitutionally-compliant.
Which is why the recent false attacks and scare-mongering, by Biden and other Democrats, on single-payer options are so unwise. The latest Biden trope is that single-payer solutions will deny Americans the right to keep their private insurance plans.
Such scare tactics could well come back to haunt the Democrats if the ACA is struck down by the courts. The ACA, with an individual mandate, was the only viable option for salvaging private insurance in the U.S., which was on the verge of collapse due to lack of affordability. That’s why the GOP could never come up with an alternative to the ACA. Going back to the bad old days before the ACA isn’t viable politically, at least not for Democrats. Which is why Biden Buttigieg, and Klobuchar, are doing real damage by seeking to undermine support for a single-payer solution. In the end, it may be America’s only hope for providing affordable health care to its citizens.