Donald Trump has tried repeatedly during the last 4 years to cripple or kill the Affordable Care Act (also called the ACA or Obamacare). He has attempted to repeal the law, both in Congress and in the courts, with limited success so far. If Trump succeeds in appointing a new Justice to the U.S. Supreme Court before January 20, the ACA will likely be killed by the Court.
What is at stake? The ACA prohibits insurance companies from discriminating against people with pre-existing medical conditions. It provides subsidies to millions to lower their premiums, allows kids to stay on their parents’ insurance until age 26, closed the doughnut hole for drugs under Medicare, and expanded Medicaid coverage to millions of low-income people. All of those provisions and many more could be stricken in a case that will be argued in the Supreme Court on November 10.
The U.S. Constitution requires the president to see that the laws are “faithfully executed.” The ACA is the law of the land. Yet, Trump has rejected his Constitutional duty and directed the Justice Department to attack the ACA in the court case. He wants it struck down in its entirety. Four of the Justices, including the two appointed by Trump, Gorsuch and Kavanaugh, are hostile to the ACA. The other four, including Chief Justice John Roberts, have supported the ACA. If confirmed, Trump’s new appointee will tip the balance, dooming the ACA.
If Trump’s Justices kill the ACA, about 20 million Americans will lose their health coverage, everyone with a pre-existing medical condition will be at the tender mercies of insurance companies as to whether they can get coverage or how much extra they will have to pay for it, and millions of low-income folks may become ineligible for Medicaid. The benefits available under insurance policies will dwindle. The entire medical system will be thrown into turmoil, and the economy with it.
The timing is certainly unfortunate, being that we are in the midst of a pandemic that has twisted the medical system in knots. Millions of people have lost their jobs, along with their employment-based medical insurance. A Commonwealth Fund survey indicated that 41% of those who lost a job because of the pandemic relied on that job for health coverage and that 20% of them were not able to get other coverage.
Trump continues to promise that he will do all he can, through the courts or otherwise, to destroy the ACA, and it is obvious his best route is through filling Justice Ginburg’s seat with a person hostile to the law. What can we do? I plan to vote for Joe Biden, who has promised to keep and improve the ACA. It is critical that voters across the country vote for a Democrat Senate majority to restore the ACA, should it be struck down by Trump’s Court appointees.
Let’s not be fooled by Trump’s claimed support for protecting those with pre-existing conditions. If he truly supported that protection, he would ask the Supreme Court to spare that existing provision in the ACA. He has not explained how an executive order can do the job--the short answer is that it cannot.
If Trump wins the election, everyone who has a pre-existing condition had best get ready to mortgage their house to cover a recurrence of their illness or get the name of a reputable bankruptcy lawyer.