I turned on the late local news Friday night to a breaking news alert. My heart sank immediately with the news that a Texas court had struck down the Affordable Care Act (aka “Obamacare”) calling it unconstitutional.
I thought immediately of all of those nearly 20 million people that have gained health insurance since the ACA was enacted: those with pre-existing conditions, young adults who were able to stay on their parent’s plan until age 26, those who weren’t offered health insurance through their employers and new Medicaid recipients.
And I thought about what it was like to be an oncology social worker before the ACA. Of having to tell patients they had no options for health insurance because they had a history of cancer or made “too much” money to qualify for Medicaid—let’s be clear these folks were barely making over $13000 per year…and that was too much. I thought about the countless individuals who delayed routine cancer screenings because they were not covered by their health insurance plans. I thought of all the people who didn’t have access to mental health or substance use treatment because these were not required benefits in health insurance plans.
We have all benefitted from the ACA since it was signed into law in 2010. It has withstood two Supreme Court cases and constant attempts to dismantle it. I hope it survives this one too.
What happened?
As part of the 2017 tax bill, the individual mandate tax (aka the penalty for NOT having insurance) was removed from the law effective January 1, 2019. However, the actual individual mandate to have insurance is still part of the law. The judge in the Texas case ruled that without the tax, the requirement of individuals to have health insurance coverage is unconstitutional. Essentially: “we can’t make them” have health insurance as this would threaten individual liberty and choice.
Most legal scholars and many legislators believe the ruling is shaky at best. The ruling will be appealed now and it is likely that it will come in front of the Supreme Court again. However, this could take months—if not years.
What does this mean for the ACA today?
- The ACA is still the law of the land. No injunction to stop provisions of the law were included in the ruling from the Texas judge on Friday.
- Open enrollment for 2019 ended on December 15thin most states. However, if you live in California, Colorado, Connecticut*, Massachusetts, Minnesota, New York, Rhode Island, or Washington DC open enrollment is still open. Click here for state specific information.
- If you have already enrolled in a plan for 2019 it is still your health insurance for 2019.
- If you lose your health insurance for a variety of reasons, you still trigger a special enrollment period and can get insurance through the Healthcare Marketplace outside of open enrollment.
*Connecticut has just changed their enrollment deadline after the Texas ruling was announced.
What’s at Stake?
Remember that the ACA is about much more than requiring Americans to have health insurance. If this ruling stands, here is what we are at risk for losing:
- Protections for individuals with pre-existing conditions: without ACA protections, insurance companies can deny coverage or charge more for coverage to individuals with pre-existing conditions. A recent study estimates the number of Americans with pre-existing conditions is around 100 million people.
- End of annual and lifetime caps: without ACA protections, your insurance company can impose an annual or lifetime cap on your insurance coverage. If you reach that annual or lifetime cap in coverage, you are left without insurance.
- Adult children would no longer be covered on their parent’s insurance plans until the age of 26.
- There will be no more coverage for essential health benefits (EHB’s): The ACA required insurance plans to cover 10 essential benefits for healthcare. Without this mandate insurance companies could decide NOT to offer or greatly limit these services as part of their plans. This would impact EVERYONE. EHB’s include:
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- Ambulatory patient services (outpatient services).
- Emergency services.
- Hospitalization.
- Maternity and newborn care.
- Mental health and substance use disorder services, including behavioral health treatment.
- Prescription drugs.
- Rehabilitative and habilitative services (like physical therapy, occupation therapy-those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices (walkers, wheelchairs, oxygen).
- Laboratory services.
- Preventive and wellness services and chronic disease management.
- Pediatric services, including oral and vision care.
What can I do?
- Call, write, or email your representatives in the House and Senate and let them know healthcare is important to you! Tell them your story. Tell them how the ACA has changed your ability to get covered and access health care. Find your Senator/Representative’s information
- Resistbot can also help you contact your elected officials electronically as well as provide you with templates and assistance in writing your message. It’s a great, free, easy to use tool.
The delivery of healthcare services is at a precipice. It is our responsibility to hold our elected officials accountable for decision making and policy development. Be your best advocate and let them know how important health care is to you, you family, your neighbors, your community, your patients, your friends—to ALL Americans. Healthcare is a human right.