The Affordable Care Act – Could This Be the Final Challenge?

John Baackes, CEO, L.A. Care Health Plan

January 31, 2019

Over the years, Congress has attempted to the repeal of the Affordable Care Act (ACA) more than 70 times, with no success. Recently a federal judge in Texas put access to care for millions of Americans in jeopardy as a result of Congressional action related to a specific portion of the ACA. The judge ruled that when Congress eliminated the financial penalty associated with the individual mandate, which required all Americans to sign up for some form of insurance, it made the landmark law unconstitutional. Seventeen states and the District of Columbia have filed an appeal of the Texas ruling, and the matter is expected to ultimately reach the Supreme Court.

Fortunately, the law will remain in effect during the appeals process, but if the Supreme Court sides with the Texas judge, it will throw the entire health care system in the United States into a state of chaos. In fact, the Urban Institute estimates 17 million Americans would lose their health insurance if the ACA were to go away.

The Affordable Care Act was never perfect, and there were always plans to make improvements, but the repeal effort overshadowed the opportunities for growth. While in need of some fixes, benefits of the ACA cannot be understated.

A Closer Look

The Kaiser Family Foundation reports that the number of uninsured has dropped by 20 million since the ACA was implemented. In California, the uninsured rate dropped from a historic 17 percent in 2013, the year before implementation of the Covered California exchange, to nine percent in 2016, the most recent numbers available.

For those who have been able to buy health insurance, many for the first time in their lives, it was made possible by a federal subsidy. The California Health Care Foundation reports that nearly 86 percent of those who purchased a Covered California plan received a subsidy – more than a million people. Nationally, 87 percent of Americans received a subsidy last year.

Medicaid expansion under the ACA has helped an additional 3.7 million Californians gain health coverage. Across America, the number is more than 14 million. Before the ACA, Medicaid covered only low-income children, pregnant women, seniors and people with disabilities. Through the ACA expansion, Medicaid now covers low-income adults, people with annual incomes below 138 percent of the federal poverty level, which is less than $12,149 for individuals or less than $25,100 for a family of four. 62 percent of those with Medi-Cal coverage who are not disabled or elderly, are working individuals trying to keep up with the increases in cost of living, and 84 percent are in working families. Those who don’t work are usually caring for a family member or pursuing an education.

While Covered California and Medicaid expansion played a significant role in getting people much needed health coverage, let’s not forget the other historic improvements the ACA created. Under the law, more than six million young adults gained health coverage through the provision that allowed children under the age of 26 to stay on their parents’ plan. This provision was meant to give young adults a coverage option at the start of their careers, when their entry-level or part-time jobs might not offer insurance.

Another critical improvement was the guaranteed coverage despite pre-existing conditions.

Because of the ACA, health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer. Before the ACA, people with pre-existing conditions were either denied insurance coverage, charged higher premiums or offered limited benefits. All of the benefits noted above illustrate the need to maintain and improve the Affordable Care Act, not to obliterate it.

What’s Next?

Upon learning of the Texas ruling, California Attorney General Xavier Becerra issued a statement saying, “Today’s ruling is an assault on 133 million Americans with pre-existing conditions, on 20 million Americans who rely on the ACA’s consumer protections for health care, on America’s faithful progress toward affordable health care for all Americans.”

Becerra is leading the appeal of the Texas ruling. If the ACA is ultimately ruled unconstitutional by the U.S. Supreme Court, America will be heading in the wrong direction on health care, back to a time when tens of millions were uninsured, and found themselves struggling to pay medical bills. Others simply delayed care until they had no choice but to turn to an emergency room where treatment is much more expensive. 

We must do better as a state and as a nation to ensure the protection of medical coverage for hard-working people who need their health to stay on the job.



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