This week saw a hearing in front of a three-judge panel of the 5th Circuit Court of Appeals in which the Trump administration argued that the Affordable Care Act should be declared unconstitutional and struck down. According to the entirety of reporting on the hearing, in law professor Nicholas Bagley’s summation, “it’s safe to say that the ACA’s defenders had a tough day in court.”
A tough day for the ACA in court portends a rough future for just about every aspect of the nation’s health care system, or at the very least a great deal of uncertainty. It’s important to point out at the outset, however, that the law is still in effect. It will remain so until and unless the Supreme Court says otherwise or a Democratic Congress and president replace it with something better. But the ongoing legal wrangling and the apparent willingness of a hyper-partisan federal court to utterly ignore the foundations of the law and advance this ridiculous case means everyone has to brace for the worst—including Republicans who still haven’t come up with an alternative.
The potential ramifications are immense. There’s been a huge focus on the more than 130 million people with pre-existing conditions who will see their protections go up in smoke. Roughly 21 million people would become uninsured, losing expanded Medicaid or coverage from the ACA marketplaces. That would also include people under age 26 on their parents’ plans. Yes, that would be over, as would the primary care everyone—whether on Medicaid, Medicare, Obamacare, or employer-provided insurance—can get without a copay now, the annual physicals and flu shots and well-child exams: all of it.
There’s just so much more however, because making a change to a system as huge and complex as ours meant a huge and complex law that extends into just about every aspect of our health.
That even includes the calorie count that restaurants have displayed with their menu choices. It includes the lactation rooms in workplaces for nursing moms. It includes wellness programs in workplaces, like smoking cessation programs.
It would also tank a Republican-sponsored provision that requires pharmaceutical companies disclose gifts to physicians. And it would seriously screw up Medicare. Because that’s the largest program administered by the federal government, many of its operations were included because that was a good way for the government to effect savings, as well as a useful laboratory for pilot projects. The law has saved Medicare billions since implementation, extending the solvency of the program. It’s also saved a lot of money for individual Medicare beneficiaries by closing the Medicare Part D coverage gap on prescriptions (the “doughnut hole”).
All the protections would go: no maximum insurance payouts ever, annually or lifetime; no jacking up of premiums based on gender or profession; guaranteed coverage of essential benefits like maternity coverage, mental health and substance abuse coverage, and prescription drugs—that’s all potentially gone, and so much more.
This is what Trump and Mitch McConnell face having to replace. This is what Trump and McConnell potentially will have to run on in 2020—the program they come up with to replace all of that, since they’ve argued that it should all go away. McConnell reiterated again this week that he’s fully behind Trump and his efforts to destroy the law. He added in the usual, “There’s nobody in the Senate that I’m familiar with who is not in favor of coverage of pre-existing conditions,” but of course wasn’t called upon to prove it by showing his plan. He’s been proven a liar by fellow Republicans time and time again over the past nine years. If it was something that mattered to them, they’d have figured it out by now.
Replacing this law, should it fall, is a serious job for serious people—and that doesn’t include Republicans.