It’s an awkward time for celebrating your birthday, especially if you are a landmark piece of healthcare legislation.
The Affordable Care Acts this week turns 10. The milestone comes amid a global pandemic. Hospitals across the country are preparing for an influx of patients that could overwhelm their acute and intensive care units. Millions of people are under some level of government-mandated shutdown designed to slow the spread of the virus. Shoppers are panic buying disinfectant wipes and hand sanitizer in an attempt to keep themselves and their families safe.
And despite all the focus on public health and the importance of the healthcare system, advocates say the ACA is still at risk of being dismantled.
The Supreme Court at the beginning of the month agreed to move forward a Trump administration case out of Texas that hopes to have the ACA deemed unconstitutional. Texas v. United States was on a path to be heard shortly before or after the November presidential election. Since then, coronavirus concerns have blossomed into a full-on crisis, and SCOTUS has postponed their work indefinitely — something that hadn’t been done since 1918 during the Spanish flu pandemic.
That no doubt pushes the timeline for hearing the ACA case back.
But the case is still alive.
“What a gross utilization of resources for this administration,” said state Assemblyman Edgar Flores on Monday during a virtual press conference celebrating the 10-year anniversary of the ACA and its impact on Nevadans. “It is irresponsible to have this conversation at this point.”
At the national level, Democratic presidential candidate Joe Biden sent a letter to Trump on Monday: “At a time of national emergency, which is laying bare the existing vulnerabilities in our public health infrastructure, it is unconscionable that you are continuing to pursue a lawsuit designed to strip millions of Americans of their health insurance and protections under the Affordable Care Act.”
Ten years ago, just before President Obama signed the ACA into law, then-Vice President Biden whispered (a bit too loudly) to him: “This is a big fucking deal.” He’s run his campaign on him being a part of the Obama administration and has promised to protect and expand the ACA. Meanwhile, Biden’s sole remaining competitor for the Democratic nomination — Sen. Bernie Sanders — founded his presidential campaign on the promise of Medicare for All.
Trump has maintained his stance against the ACA even as the novel coronavirus has spread across the country. “What we’d like to do is totally kill it, but come up — before we do that — with something that’s great,” he said of Obamacare during a town hall in Pennsylvania earlier this month.
Trump made similar comments during a White House briefing on Sunday, reports USA Today.
At the same time, several states have used emergency powers to launch “special enrollment periods” allowing their residents to sign up for health insurance through state-run marketplaces set up as part of the ACA. Nevada was one of them.
The Trump administration is considering launching a special enrollment period nationwide, reports Politico. That would benefit states that did not set up their own marketplaces.
Even without a special enrollment period, untold numbers of people will be eligible to sign up for insurance through the public marketplace once their employer-based insurance goes away as a result of widespread layoffs.
Several healthcare companies have publicly committed to providing testing and treatment of COVID-19 at no cost to the consumer. But keeping that promise may be unrealistic, especially when considering the dearth of testing currently available and the possibility that surviving the disease may leave people with permanent lung damage.
Joseph Merlino, a local healthcare advocate and cancer survivor, said the country needs to protect the ACA “now more than ever.”
“People will die not just from this terrible affliction but in the ensuing aftermath,” he said. “Healthcare is a right, not a privilege for the rich and well connected.”
Destroying the ACA would mean insurance companies could — as they did pre-Obamacare — decline coverage over preexisting conditions, implement lifetime maximums that people with severe or rare conditions would quickly reach, charge women more than men, and kick off young adults as soon as they turned 18 years old.
“We would be forced into bygone days,” added Merlino. “People would have to choose eating and shelter over health care. Young people would go uninsured. Junk plans would prevail.”
According to the Urban Institute, approximately 282,000 Nevadans could lose their coverage if ACA was repealed. That figure includes 74,000 children, 19,000 young adults and 95,000 Latinos.
For Merlino, the ACA is deeply personal. The cancer survivor says complications stemming from his rare form of throat cancer led to him losing his employer-based health insurance, and he would not have been able to afford insurance without the ACA. Through Medicaid, and later through a plan purchased through the ACA, he was able to get the surgeries he needed and eventually get back into the workforce.
Many aspects of the ACA — such as protections for people with preexisting conditions — are largely popular. The Center for American Progress estimates that 1.2 million Nevadans have a pre-existing condition.
Overall, public support for the ACA has also grown over time as people recognize the importance of affordable healthcare and see the data showing its success, said Andres Ramirez, a local healthcare advocate.
“Especially in situations like this,” he added, referring to the pandemic.
SCOTUS has faced and upheld the ACA before, though its makeup when doing so was notably different. In 2012, their ruling gave states the authority to reject or implement Medicaid expansion as part of the ACA. Former Gov. Brian Sandoval became the first Republican governor in the country to opt in to Medicaid expansion, a move he and advocates have since defended for bringing health care to tens of thousands of Nevadans.
Nevada’s Medicaid program is currently seeking emergency waivers from the federal government to streamline and accelerate access to their services.