“The Affordable Care Act’s achievements are clear. People who buy insurance in the individual and small-group markets no longer face discrimination for preexisting conditions. Preventive services for Americans with all types of insurance are free. Combine the marketplaces that provide tax subsidies for private coverage and the Medicaid expansions adopted by 38 states (along with a handful of smaller provisions), and the ACA has provided coverage to about 31 million Americans, according to a new estimate from the Biden administration.
After the rocky rollout of HealthCare.gov in 2014 and a few years of soaring premiums, the law’s private marketplaces have stabilized”
“one of the biggest gaps in the ACA itself: Medicaid. The program’s expansion to cover more low-income adults was supposed to be mandatory for all 50 states, a statutory overreach that was scaled back by the Supreme Court, where two liberal justices joined the conservatives to rule that the expansion must be optional.
As a result, 12 states still refuse to expand Medicaid. An estimated 4 million people who would have been covered by the expansion remain uninsured.”
“Some people who purchase private insurance through the law can still face high out-of-pocket costs. Some of the health plans sold on the marketplaces have deductibles as high as $6,000 for an individual or $13,000 for a family — and those are usually the cheapest plans available. Until this year, people who made too much money to qualify for the law’s subsidies had to pay the full cost for their insurance, making it unaffordable for some.”
“one core problem remains: While every other developed country in the world enjoys universal (or near-universal) health coverage, 1 in 10 people living in the United States still don’t have insurance.
That number is lower than it was before 2010, when it was about 17 percent. But it is an embarrassing outlier among our economic peers. Americans also spend more of their own money on their health care than people in almost every other country.”
“America spends more money on health care for worse outcomes than its peer countries, as researchers have noted time and again. On a global index of health care quality and access, the US trails many more socialized systems. Life expectancy has dipped in recent years, ending decades of progress and dropping the US further behind comparable countries.
There is no denying that the high quality of health care available in the United States — for those who can afford it. The US health care industry can undoubtedly be among the most innovative in the world: It was American science that cured hepatitis-C in the last decade. The success of the country’s Covid-19 vaccine development, production and distribution is undeniable.
But prioritizing innovation above all else creates its own problems, leaving US health policy captive to private interests.”
“nearly a decade after the Supreme Court ruled that states could choose whether to expand their Medicaid programs, the fight over whether to do so is far from over. So far, 38 states and Washington, DC, have expanded Medicaid, covering nearly 15 million people. In the dozen states that have not, 4 million people are uninsured who would receive Medicaid coverage if their state expanded eligibility under the ACA. More than 95 percent live in the South, they are disproportionately Black, and many are not eligible for subsidies to buy private coverage on the ACA markets.”
“Supreme Court nominee Amy Coney Barrett is a critic of Roberts’s decisions upholding most of Obamacare. In a book review published in 2017, for example, Barrett denounced Roberts’s opinions in both NFIB and King, claiming the chief justice “pushed the Affordable Care Act beyond its plausible meaning to save the statute” in the first decision.
If Obamacare is struck down, roughly 20 million Americans will lose health coverage — a likely conservative estimate, as it does not count many people who have lost their employer-provided health insurance during the Covid-19 pandemic.
Questions over Obamacare have taken a starring role in Barrett’s confirmation hearing. Democratic senators have repeatedly brought up Barrett’s objections to the NFIB and King decisions and frequently referred to California v. Texas, a third case attacking Obamacare that the Supreme Court will hear in November.
Barrett didn’t deny criticizing the NFIB and King opinions, but suggested that perhaps she didn’t engage in particularly rigorous analysis when she attacked those two decisions.
After Sen. Amy Klobuchar (D-MN) asked Barrett about a 2015 NPR interview in which the future judge claimed the dissenting justices had the “better of the legal argument” in King, Barrett said she was merely a law professor when she made that statement. “A professor professes and can opine,” Barrett claimed, adding that she did not go through the “judicial decision-making process” when she determined that King was wrongly decided.”
“Barrett’s record..suggests she is a long-term threat to the viability of the ACA — even though the Court may very well still reject the unusually shaky legal arguments in Texas.”
“The US Supreme Court issued its ruling in Little Sisters v. Pennsylvania Wednesday, holding the Affordable Care Act gives the Trump administration broad authority to grant exceptions to a federal regulation requiring employers to provide birth control coverage to their employees.
On the surface, Justice Clarence Thomas’s majority opinion appears to be focused exclusively on birth control, and it also endorses a policy that could cease to exist in less than a year.
The immediate upshot of Little Sisters is to let stand Trump administration rules allowing employers opposed to birth control to refuse to provide contraceptive coverage to their employees. If presumptive Democratic nominee Joe Biden becomes president next year, however, his administration could repeal the Trump administration’s policy and implement a new policy more favorable to contraception coverage.
But dig just one inch below the surface of Justice Thomas’s opinion, and it has deeply radical implications: Little Sisters opens up a new front in the seemingly endless judicial war on Obamacare. And it gives Republicans a new weapon it can use to attack the landmark legislation President Obama signed more than a decade ago.
Thomas’s opinion does not simply allow the Trump administration to limit many individuals’ access to birth control, it could also allow courts to dismantle a key provision of Obamacare that ensures patients receive preventive care without having to pay out-of-pocket costs.”
“Millions of Americans losing their jobs may still be able to sign up for Obamacare — but Trump officials haven’t been urging people to grab onto that safety net while they can.
People who’ve lost their workplace health insurance during the coronavirus outbreak may qualify for private coverage through Obamacare, along with generous subsidies, despite President Donald Trump’s decision last week not to re-open signups for everyone. Many may also qualify for free or low-cost coverage under Medicaid, especially in the two-thirds of states that joined Obamacare’s expansion of the low-income health care program.
Some states that depend on Healthcare.gov are trying to broadcast these options to their citizens — through media campaigns, the governors’ microphones, social media and patient groups — while advocates say the federal government needs to bring in money and a marketing plan to help.”
“most of the 12 states and the District of Columbia that run their own ACA exchanges have reopened their markets.”
“For those advocacy groups or insurers who do try to spread the word, the enrollment task is made even more challenging by steep cuts the Trump administration made to the government’s Obamacare outreach. That started soon after Trump took office and intensified right through the most recent open enrollment, which ended in mid-December.”
“the usual red-tape involved in getting people who qualify for special sign-ups into ACA plans has only grown more complicated and cumbersome in the time of social distancing — when people can’t just present the documents they need to an insurance broker and fill out the necessary forms in real-time. The process is even harder if the person trying to get covered doesn’t have access to a computer. During normal signup seasons, people can call for help, go use a library computer, or get help from a broker or ACA navigator.
The Trump administration says its plan to pay Covid-19 hospital bills is better, as it promises to make direct payments for care.
But critics note that’s not health insurance. It won’t help a newly uninsured person who breaks a leg, has a heart attack, or is undergoing chemotherapy.”
“People who lose jobs can get COBRA, meaning they can extend their job-related insurance after being laid off. But that is massively expensive — particularly for anyone who has just lost their livelihood.”
“People have just 60 days after losing job-based coverage to get documentation in order and figure out a new plan.”
“At the end of 2019, Congress repealed three significant tax components of the Affordable Care Act, a.k.a. Obamacare. Each of them had been included in the initial legislation to raise the revenue required to pay for the new spending the law called for.”
“What’s the problem with the repeal of a bunch of taxes no one ever really liked? That’s probably what the lawmakers who voted to end the taxes were thinking too. The main effect will be to increase the deficit by a little more than $373 billion over the next decade—and, in the process, to further weaken a central argument made by supporters of the legislation.
Obamacare was passed on a promise that it would be deficit-neutral or even reduce the deficit slightly. The Congressional Budget Office estimated that the law would reduce the deficit during its first decade, provided that all of its provisions were enacted as the statute called for. As The New York Times noted last summer, the Cadillac tax “was expected to be a key cost-containment provision in President Barack Obama’s signature health law and one of the main ways it was supposed to pay for itself.”
There are obvious lessons here about what we might expect from various plans to “pay for” Medicare for All now being touted by various Democratic presidential hopefuls. If nothing else, this episode is a reminder of how Washington works: First, Congress passes a law setting up an expensive new program along with (if we’re lucky) a system to pay for it. Years later, amid a bipartisan spending binge, those taxes are repealed while the rest of the program remains on the books. The public barely notices, and the lawmakers involved shrug and move on.”
“at the tail end of 2019, Congress repealed three significant components of Obamacare.
The three repealed provisions were all taxes, each of which was included in the initial legislation as a way of raising revenue to pay for the hundreds of billions in spending the law called for. By far the biggest of the three was the so-called Cadillac tax, which was expected to raise about $197 billion over the next decade. Congress also nixed the law’s health insurance tax, projected to raise $150 billion over 10 years, and the medical device tax, projected to raise $25.5 billion. All three taxes were eliminated as part of a $1.4 trillion year-end budget bill that President Trump signed at the last possible minute in order to keep the government open.”
“The elimination of three health care taxes will increase the deficit by $373 billion.”
“In the Netherlands, people who don’t sign up for their universal private coverage during the annual enrollment period are automatically enrolled in a plan and have to pay a premium 20 percent higher than what they would have paid if they signed up voluntarily. The Dutch have achieved 99 percent coverage under such a system, which shares other features with Obamacare (like subsidies and the ban on preexisting conditions).”