The arrival of COVID-19 has made it dramatically clear that having health insurance is not just important for individual health, but for public health as well. Those with coverage are less likely to let cost deter them when deciding whether to get tested or seek other care. Taking these actions in turn benefits us all by helping track and contain the spread of the disease caused by a new strain of coronavirus.
This is a particularly ill-advised time to pursue rolling back the historic coverage gains enabled by the Affordable Care Act (ACA), the 10-year-old health reform law passed under former President Barack Obama. Regrettably, efforts are steaming ahead to do just that, with the support of President Donald Trump’s administration.
The law’s fate is once again in the hands of the U.S. Supreme Court’s nine justices. Last week, the high court agreed to hear Texas v. Azar, the third major court case challenging the ACA’s constitutionality. The law survived the first two challenges. But this time, the Department of Justice is not fulfilling its traditional role of fully defending the law, even though an adverse ruling could overturn it, creating upheaval that would ripple across the entire health care system.
Particularly hard hit would be the families who rely on the ACA’s landmark consumer insurance protections for those with pre-existing health conditions. And, those who rely on the law’s help to buy private coverage or qualify for public medical programs.
The ACA fueled insurance coverage expansions by providing financial assistance to instantly discount monthly premiums for those who qualified. It also expanded eligibility for Medicaid, the public health program for the poor, elderly and disabled.
In Minnesota, a little-used lever in the law allowed the state to strengthen the pioneering MinnesotaCare program, which provides coverage for those who earn too much to qualify for medical assistance but not enough to comfortably afford buying private insurance. One of the improvements: removing MinnesotaCare’s antiquated $10,000 cap on hospitalization coverage. The program provides coverage for roughly 100,000 Minnesotans. Weakening this important program’s benefits would be a reprehensible step backward.
The Supreme Court will hear the case this fall, meaning a ruling isn’t expected before voters cast their ballots this November. But the potential fallout from its decision should be front-and-center during this election year.
So far, Trump has not released a plan to replace the ACA or one to serve as a stopgap should the law be struck down. Minnesota also has a Senate race this year, and all members of its House delegation are running for re-election. They should face hard questions about coverage losses.
Recent calculations by the Center for American Progress, a think tank based in Washington, D.C., suggest that Minnesota’s uninsured rate among the non-elderly could go from 7% to 12.5% if the law is invalidated. That translates to 265,000 people in the state losing coverage. More than 2 million Minnesotans with pre-existing conditions also depend on protections, the group said.
Minnesota’s health commissioner, Jan Malcolm, sounded the alarm about the court case’s impact at recent legislative hearing. She noted that the law is an important source of federal funding for state and local public health programs, including the state laboratory that will play a vital role in combating COVID-19. Around $98 million has flowed here for these efforts over the past decade, she said.
After 10 years, the ACA is an essential part of this nation’s health care foundation. It’s ludicrous to think it could be unwound with ease and without harm, a reality driven home again by the new challenge to contain COVID-19.