What is the future of ObamaCare (ACA)?

Dear friends and colleagues,

2020 has been an unprecedented year in politics, public health, and scientific innovation.

Affordable Care Act had its initial oral argument hearing on the Supreme Court on Nov 10. Supreme Court will not decide on ACA repeal until likely June 2021.

Impact: Striking down the ACA could cause 21 million people to be uninsured in USA

• Most affected are low-income adults who became eligible for Medicaid under law

• Millions of Americans would also lose private insurance. This includes young adults staying on their parents plans until they turn 26

• Coverage for pre-existing medical conditions, emergency care, prescription drugs and maternity care could be affected

The ACA is one of the most controversial laws. Jimmy Kimmel once asked people on the street whether they preferred ObamaCare or ACA. People said they preferred the ACA because “they don’t like Obama” even though they are the same thing.

Let’s go back to the basics of Pros and Cons of ObamaCare aka ACA

By and large, the ACA has decreased the number of uninsured Americans. From 49 million uninsured Americans in 2010 to 30 million in 2019. However, it required everyone to get health insurance even if they are healthy (although penalty was removed by Trump’s Tax Cuts and Jobs Act in 2017), and it raised income taxes. 

3 Topics for Supreme Court on ACA:

There are 3 core issues of litigation against ACA discussed during the Supreme Court:

1)    Whether plaintiff have standing to sue? Translate: Can some states led by Texas and 2 individuals sue ObamaCare due to injury caused by the law?

• The individuals felt compelled to buy ACA-compliant coverage. Simply because it was the law, even though there is a $0 penalty.

• Analogy: Would you challenge a law requiring people to mow their lawn each week, with a $0 fine for violating that law?

2)    Is the individual mandate unconstitutional? Translate: Is the law to require everyone to purchase health insurance still a law if the penalty is $0?

• As mentioned, the mandate used to have a penalty if someone did not buy health insurance. That penalty became $0 in 2019.

• Analogy:  If a tree falls in the forest and no one’s listening, does it make a noise?

3)    If the individual mandate is unconstitutional, is it severable from the rest of the ACA? Translate: if the main part of the ACA is no longer legal, does it dismantle the rest of the act?

• There are several provisions of the ACA, such as protection against pre-existing conditions. Could these go down along with the individual mandate?

• Analogy: If an elephant loses its trunk, is it still considered an elephant?

Potential Outcomes:

It is hard to predict what the ruling would be in June, but initial oral arguments seem to suggest that the ACA will not be struck down in its entirety. 

Is the ACA perfect? No, but I have yet to see the alternative from the Trump Administration 2 months from the Biden inauguration. Would love to hear suggestions for improving health policies (maybe one is to not name it after politicians).

For the past decade, ACA has been ingrained in the US healthcare system. The decision to repeal is not a slight one, with signifiant impact on peoples’ lives.

Stay vigilant,

Katherine

To read more in detail on ACA, please read Health Affairs article by Katie Keith: https://www.healthaffairs.org/do/10.1377/hblog20201111.916623/full/

P.S. Post the UK approval of the Pfizer vaccine, a few upcoming dates to watch:

• 10 Dec – Pfizer FDA potential approval 

• 14 Dec – Potential rollout of Pfizer vaccine

• 17 Dec – Moderna FDA potential approval 

I will post a concise analysis for you once these results roll in. Stay tuned in the next few weeks.