If the Affordable Care Act really does fall in the hyper-partisan courts, following last week’s bananas decision by Texas federal Judge Reed O’Connor to declare the whole thing unconstitutional, it’s not going to just hurt the people who gained coverage under the law. It’s going to screw everyone. Kaiser Health News counts the 5 ways it could “upend the entire health system.”
“To erase a law that is so interwoven into the health care system blows up every part of it,” said Sara Rosenbaum, a health law professor at the George Washington University School of Public Health. “In law they have names for these—they are called super statutes,” she said. “And [the ACA] is a super statute. It has changed everything about how we get health care.” That concept was developed by Abbe Gluck, a professor at Yale Law School.
First off, about 20 million people could directly lose coverage, immediately. That’s when Medicaid expansion disappears and there’s no longer federal subsidies to help people pay for coverage. But beyond that are the end to the other parts of the ACA, including its ban on restrictions for people with preexisting medical conditions and allowing adult children to stay on their parents’ health plans until reaching age 26.
Secondly, the whole healthcare system has been reengineered in the way providers approach care, since they’re not having to spend “considerable time and effort figuring out how to treat those without insurance and not go broke.” They’ve instead started new approaches that focus on improving the quality of care and to “improve health across the population through initiatives like improving the availability of healthful food, bicycle paths and preventive care.” That would all be out the window and they’d be back having to figure out how to just provide care and stay in business.
Additionally, it would drastically change Medicare and Medicaid and start costing seniors and disabled people more again. For example, free preventive care (for everyone) would be gone. The savings on prescription drugs that came with closing the “doughnut hole”—the coverage gap between what Medicare covered and what had to be picked up out of pocket—would be gone. And seniors have saved millions, collectively, with that reform. The program has restructured how it pays for hospital, home health, and outpatient care, all of which would have to be changed again. The law has saved Medicare billions of dollars and extended its solvency, and that would be over. Millions would lose Medicaid coverage, but states would also lose a big boost to Medicaid prescription drug rebates which has saved them billions since the law went into effect. They’d also have to pick up the cost of care for people losing Medicaid again.
Fourth, a wide array of systemic changes under the law would be swept away: the power given to the FDA to approve generic versions of expensive biologic drugs; permanent spending authority for the Indian Health Service to provide a range of programs for Native Americans; grant programs for training health professionals; protections for people with employer-based coverage through the Health Insurance Portability and Accountability Act, or HIPAA which was inextricably tied to the ACA. That’s just a smattering of the programs the ACA reached into.
And, oh yeah, a bunch of the Trump administration’s health priorities would suffer, too. Like fighting the opioid epidemic, which depends on Medicaid dollar, the single largest payer for mental health and substance abuse care. And his plan to limit drug prices “through the Center for Medicare & Medicaid Innovation (CMMI), which was created by the ACA and would lose its legal authority if the law became invalid.”
Saner heads are likely to prevail here, even in a Republican-heavy judiciary. For one thing, people smarter than Trump and Judge O’Connor are likely to realize just how disastrous the entire law going away would be for Trump and Republicans. If it gets that far, Chief Justice John Roberts will certainly consider that.
This is a Creative Commons article. The original version of this article appeared here.