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WASHINGTON (AP) – When the Supreme Court assesses the fate of ‘Obamacare’, arguments revolve around obscure legal points like severability – whether judges can surgically extract part of the law and leave the rest.
But what’s at stake has tangible consequences for just about all Americans, as well as the health care industry, a major source of jobs and tax revenue. Whether the Affordable Care Act remains, disappears, or is significantly changed, it will affect the way life is lived in the United States.
The argument against the law of the Trump administration and conservative states is that the 10-year-old statute was made unconstitutional in its entirety when Congress reduced a penalty to zero for those who remained uninsured. The court has firmly shifted to the political right under President Donald Trump. Here’s a look at what is at stake if opponents of the law win:
COVID-19 A NEW PRE-EXISTING CONDITION
Before the ACA, insurers could deny a person for an individual policy, or charge them more, based on their medical history. The Non-Partisan Kaiser Family Foundation estimates that around 54 million working-age adults have health issues that would have made them “uninsurable” before former President Barack Obama’s signing law.
Tens of millions more have issues that could have resulted in higher premiums. The female gender was one, as insurers routinely billed women more.
COVID-19 is believed to become America’s newest pre-existing disease, for more than 10 million people who have tested positive so far.
Under the ACA, a coronavirus case cannot be used to deny someone coverage or charge them more. If Obamacare is gone, it becomes a real question.
Trump promised to always protect people with pre-existing conditions, but never said how he would do it.
COVERAGE OF OVER 20 MILLION
The ACA’s two main programs to cover the uninsured would be wiped out if the law was overturned, leaving more than 20 million people uninsured unless a divided Congress could put in a new safety net.
About 12 million low-income people are covered by the Medicaid extension of the Health Act, now available in most states. Most of them are adults who work in low-paying jobs and do not have health insurance. Some have lost jobs at businesses like hotels, restaurants and cinemas, which continue to struggle due to the pandemic.
Another group, over 11 million people, has private coverage purchased from taxpayer-subsidized private markets such as HealthCare.gov
It is also in danger.
PREVENTION
Most American women no longer pay out of pocket for birth control. This is covered as a preventive service, free to the patient, under the ACA.
Many other services, from colonoscopies to flu shots, are also free.
If people again face copay for routine preventive care, it may discourage some from taking tests that detect diseases like cancer at an early stage when they are easier to treat.
RETURN OF A GAP MEDICINE
“Obamacare” took the first major steps to close Medicare’s unpopular “donut hole”, a coverage gap that left seniors on the hook for hundreds of dollars in prescription drugs. Congress then accelerated the schedule.
Repealing the ACA would mean the return of the coverage gap, which is sure to infuriate older voters, many of whom say their drugs are still too expensive.
This is just one of the many potential consequences for Medicare. The ACA has slowed payments to hospitals and insurers to extend the duration of the Medicare trust fund.
LONGER SHORT TRACK
One of the first benefits to come into effect after the adoption of “Obamacare” was the requirement that insurers allow young adults to stay on a parent’s plan until they are 26 years old.
This provided a longer economic trail for millions of young adults, who at the time were struggling with the lingering effects of the Great Recession. Today, these are the consequences of the coronavirus economy.
Before the extension of ACA coverage, insurers routinely cut young adults after graduation.
RICH INCOME TAX REDUCTION
“Obamacare” has raised taxes on high income earners to help fund the expansion of its coverage.
If the entire law is repealed, it would result in a tax cut for the affluent, many of whom escaped the economic shock of the COVID-19 pandemic because stock investors continued to do well.
RUBIK’S POLITICAL CUBE
Passing the 900-plus-page ACA was a political challenge that took over a year at a time when Democrats controlled the White House and both houses of Congress.
Putting together a replacement under a divided government would be the ultimate political puzzle. Neither Democrats nor Republicans agree, even in their own ranks, what that should look like.
President-elect Joe Biden would build on the ACA by improving it and adding a new option for public health insurance. But Liberal parties want a government-run system for all Americans, including the $ 160 million covered by employer plans.
Many Republicans, meanwhile, want to cut government support for health care. They would make deep cuts in Medicaid funding and leave the ACA insurance markets as an option of the state. Protections for people with pre-existing conditions could be eroded under new rules.
Trump once said, “No one knew health care could be so complicated.” It was in 2017, when he and a Republican-controlled Congress had hopes that they could “repeal and replace” the ACA.
That didn’t happen back then because Republicans could never agree on what a replacement would look like.
Fast forward to 2020. Healthcare only gets more complicated.
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