Health Care Alert: What’s At Stake In Pending Supreme Decision On Affordable Care Act

This month, and as early as Monday, the Supreme Court is set to rule on California v. Texas, former President Trump’s signature lawsuit seeking to overturn the entire Affordable Care Act (ACA), end its protections for 135 million Americans with pre-existing conditions and rip health care away from more than 20 million Americans. Despite President Biden’s overwhelming support for the health care law, 18 red states remain on the lawsuit to finish the job and throw the entire health system into chaos. As we are still recovering from the health and economic fallout of the coronavirus pandemic, the future of our health care is at stake.

This ruling will come after President Biden signed the American Rescue Plan into law, which dramatically lowered health care costs for millions of people purchasing coverage on the ACA marketplaces. Experts say that as many as 25 million Americans stand to gain coverage or see their health care costs reduced under this historic legislation. In fact, nearly seven million uninsured people can now purchase an ACA plan with no monthly premium at all. And thanks to President Biden opening a special enrollment period, more than one million people have already been able to gain coverage since February. Striking down the health care law could be especially disastrous as Americans are relying on the ACA now more than ever. 

Special Online Resources:

State-specific fact sheets on impact of the Texas lawsuit

State-specific fact sheets on the American Rescue Plan

Fact Sheet On The Trump Lawsuit To Overturn ACA

What Abolishing The ACA Means: 

• GONE: Protections for 135 million Americans with pre-existing conditions. The uninsured rate will increase by 69 percent. 
• GONE: Medicaid expansion, which covers more than 15 million people. 
• GONE: Nearly 12 million seniors will have to pay more for prescription drugs because the Medicare ‘donut hole’ will be reopened.
• GONE: 2.3 million adult children will no longer be able to stay on their parents’ insurance. 
• GONE: Insurance companies will be able to charge women 50 percent more than men.
• GONE: Financial assistance that helps 9 million people purchase health care in the marketplace.
• GONE: Key support for rural hospitals. 
• GONE: Ban on insurance companies having lifetime caps on coverage.
• GONE: Requirements that insurance companies cover prescription drugs and maternity care.
• GONE: 60 million Medicare beneficiaries will face higher costs and disruptions to their medical care.

If Republicans Get Their Way, More Than 20 Million People Would Lose Their Coverage

• 21 Million People Would Lose Coverage. Estimates from the Urban Institute show that 21.1 million people would lose coverage if the Supreme Court overturns the ACA. As the uninsured rate swells, so will the amount of uncompensated care, which Urban predicts will grow by at least 74 percent.
• The Uninsured Rate Would Increase By 69 Percent. According to estimates from the Urban Institute, the number of uninsured Americans would increase from 30.8 million to 51.9 million without the ACA, representing a 69 percent increase in the uninsured rate. Americans of all ages would be impacted by coverage losses:
• 1.7 million children would become uninsured, an increase of 48 percent. 
• 4.9 million young adults aged 19 to 26 would become uninsured, an increase of 76 percent. 
• 8.8 million adults aged 27 to 49 would become uninsured, an increase of 60 percent.  
• 5.6 million million older adults aged 50 to 64 would become uninsured, an increase of 95 percent. 
• States Would Lose Important Federal Health Care Funding — an estimated reduction of $152 billion in the first year. The Urban Institute estimates that a full repeal of the ACA would reduce federal spending on health care by $152 billion per year beginning in 2022.

Overturning The ACA Would Exacerbate Racial Disparities In Coverage

The uninsured rate for Black Americans would spike to 20 percent, 24 percent for American Indian/Alaska Natives, 19 percent for Asian/Pacific Islanders, and 30 percent for Hispanics — compared to 15 percent for white Americans. 

• 3.1 Million Black Americans Would Lose Coverage. The Urban Institute estimates that 3.1 million Black Americans would become uninsured if the ACA were overturned. According to the Center on Budget and Policy Priorities, the ACA helped lower the uninsured rate for nonelderly African Americans by more than one third between 2013 and 2016 from 18.9 percent to 11.7 percent. 
• 5.4 Million Latinos Would Lose Coverage. The percentage of people gaining health insurance under the ACA was higher for Latinos than for any other racial or ethnic group in the country. According to a study from Families USA, 5.4 million Latinos would lose coverage if the lawsuit succeeds in overturning the ACA.
• 1.3 Million Asian/Pacific Islanders Would Lose Coverage. 1.3 million Asian/Pacific islanders would become uninsured if the ACA were overturned, according to estimates from the Urban Institute. Research shows the ACA cut uninsurance rates among Asian Americans by more than half–from nearly 20 percent to just under 8 percent– eliminating coverage disparities with white Americans.
• 488,000 American Indians And Alaska Natives Would Lose Coverage. According to the Urban Institute, the uninsurance rate for American Indians and Alaska Natives would more than double in 10 states if the ACA is overturned. Nationwide, 488,000 would lose coverage. 

Republicans Want To Put Insurance Companies Back In Charge, Ending Protections For The 135 Million People With A Pre-Existing Condition

• According to an analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. This includes:
  • 44 million people who have high blood pressure
  • 45 million people who have behavioral health disorders
  • 44 million people who have high cholesterol
  • 34 million people who have asthma and chronic lung disease
  • 34 million people who have osteoarthritis and other joint disorders

• More than 17 million children, 68 million women, and 32 million people aged 55-64 have a pre-existing condition.

Republicans Want To Give Insurance Companies The Power To Deny Or Drop Coverage Because Of A Pre-Existing Condition

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. Now insurance companies could have the license to do this again. 

• A 2010 congressional report found that the top four health insurance companies denied coverage to one in seven consumers on the individual market over a three year period. 
• A 2009 congressional report found that some of the largest insurance companies had retroactively canceled coverage for 20,000 people over the previous five year period.
• The Kaiser Family Foundation estimates that 54 million people, or 27% of adults aged 18 to 64, have a condition that would have been grounds for coverage denial in the pre-ACA marketplace. 

Coronavirus Could Now Be Considered A Pre-Existing Condition. Without the ACA, millions of Americans who have contracted the coronavirus would likely be deemed as having a pre-existing condition and be at the mercy of their insurance companies who could refuse to pay for needed care. 

Source: Kaiser Family Foundation

Republicans Want To Give Insurance Companies The Power To Charge You More, While Their Profits Soar

• Premium Surcharges Could Once Again Be In The Six Figures. Without the ACA, insurance companies could once again charge people more because of a pre-existing condition. The House-passed repeal bill had a similar provision, and an analysis by the Center for American Progress found that insurers could charge up to $4,270 more for asthma, $17,060 more for pregnancy, $26,180 more for rheumatoid arthritis and $140,510 more for metastatic cancer.
• Women Could Be Charged More Than Men For The Same Coverage. Prior to the ACA, women were often charged premiums on the nongroup market up to 50 percent higher than men were charged for the same coverage. 
• People Over The Age of 50 Would Face A $4,000 “Age Tax.” Overturning the ACA means insurance companies could charge people over 50 more than younger people. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the Republican repeal bills, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, according to the AARP.
• Nine Million People In The Marketplaces Would Pay More For Coverage. Without the ACA, consumers would no longer have access to tax credits that help them pay their marketplace premiums, meaning roughly nine million people who receive these tax credits to pay for coverage would have to pay more.
• Seniors Would Have To Pay More For Prescription Drugs. Without the ACA, seniors would have to pay more for prescription drugs because the Medicare “donut” hole would be reopened. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 Centers on Medicare and Medicaid Services report.
• 60 Million Medicare Beneficiaries Could Face Higher Costs. In addition to paying more for preventive care and prescription drugs, Medicare beneficiaries could face higher premiums without the cost-saving measures implemented under the ACA. Without the ACA, seniors would also face less coordinated care. 
• Insurance Companies Would Not Have To Provide The Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.

Republicans Want To Give Insurance Companies The Power To Limit The Care You Get, Even If You Have Insurance Through Your Employer

• Insurers Could Reinstate Lifetime And Annual Limits On 109 Million Privately Insured Americans. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage for those insured through their employer or on the individual market. In 2009, nearly 6 in 10 (59%) covered workers’ employer-sponsored health plans had a lifetime limit, according to the Kaiser Family Foundation. 
• 138 Million Americans Could Once Again Have To Pay For Preventive Care. Because of the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no cost to consumers. This includes nearly 138 million Americans, most of whom have employer coverage.
• Employers Could Eliminate Out-Of-Pocket Caps, Forcing Employees To Pay More For Care. Under the ACA, health insurers and employer group plans must cap the amount enrollees pay for health care each year. If the law is overturned, these cost-sharing protections would be eliminated. The ACA also barred employer plans from imposing waiting periods for benefits that last longer than three months.

Republicans Want To End Medicaid Expansion

• More Than 15 Million People Enrolled Through Medicaid Expansion Would Lose Coverage. Before the coronavirus crisis, roughly 15 million people were enrolled through Medicaid expansion. 
• Medicaid Plays A Critical Role In The Coronavirus Response. An estimated 14 million people have lost their employer-sponsored coverage as a result of the pandemic, and states are reporting steep increases in Medicaid enrollment. The Center on Budget and Policy Priorities found that roughly 6 million people enrolled in Medicaid between February and July 2020.  
• Access To Treatment Would Be In Jeopardy For 800,000 People With Opioid Use Disorder. Roughly four in 10, or 800,000 people with an opioid use disorder are enrolled in Medicaid. Many became eligible through Medicaid expansion.
• Key Support For Rural Hospitals Would Disappear, with uncompensated care costs for hospitals rising by $17.4 billion in 2022. 

Republicans Are Willing To Sacrifice Your Care For More Tax Cuts For The Wealthy

• The Richest Americans Would See Tax Cuts Averaging $200,000. Overturning the ACA would cut taxes for the top 0.1 percent of earners by an average of $198,000.
• Drug Companies Would Save Billions. If the ACA is struck down, pharmaceutical companies would pay $2.8 billion less in taxes each year.
• Repeal Would Weaken The Medicare Trust Fund. A significant portion of the tax cuts resulting from ACA repeal would come “at the direct expense of the Medicare Trust Fund,” according to the Center on Budget and Policy priorities.