On November 10, the U.S. Supreme Court will hear the Trump Administration’s arguments in its lawsuit to abolish the Affordable Care Act (ACA, or “Obamacare”). One of the promises Donald Trump ran on in 2016 was to strike down Obamacare, which he frequently calls “a disaster.” Ten years after the Obama Administration passed the Affordable Care Act, many Americans are still confused or completely in the dark about what it is, and how it impacts them. This is due in large part to misinformation and conspiracy theories spread (and even paid for) by opponents of the Affordable Care Act.
Though Donald Trump has promised a bigger, better health care plan to replace Obamacare, the unveiling of his plan has been “two weeks away” for more than three years. The GOP has made some weak efforts to create a replacement plan, but they have not been able to reach agreement on a bill. It’s clear that destroying the ACA is more important to Donald Trump and his base than ensuring that Americans have viable access to affordable health care.
If the Trump administration’s efforts to eliminate Obamacare are successful, it will impact most Americans with health care coverage in some way, even if they receive private health insurance through an employer. Many Americans are not aware of the protections the Affordable Care Act has created for all health care recipients in the U.S., regardless of where they get their health care coverage. Some of these are benefits that we all have come to take for granted. Others that impact all of us are less well-known.
One of the most popular aspects of The Affordable Care Act is its requirement that insurers cover patients with pre-existing conditions at no additional charge. This means that insurers may not deny coverage for those with pre-existing conditions, and they are not allowed to charge higher premiums. After the passage of the Affordable Care Act, many Americans could, for the first time, afford to purchase competitive health insurance.
Though Donald Trump promises that his health care plan will continue to cover those with pre-existing conditions, he has not committed to how it will cover them; will they be covered, but at an exorbitant cost, as was the case with many insurers before the Affordable Care Act? Will they be subjected to extended waiting periods, or only be offered limited coverage? Will Trump disregard this promise regarding pre-existing conditions altogether?
This is an important consideration, as it’s estimated that, according to the Department of Health and Human Services, 19 to 50 percent of non-elderly Americans have pre-existing conditions. The spread of COVID-19 in the U.S. will increase that number, as many “long-haulers” who have survived the virus continue to suffer organ damage, respiratory issues, neurological issues, and more.
Wellness and preventive visits
Before the Affordable Care act, many private insurance companies didn’t cover wellness exams, or they only covered a percentage of the cost. The Affordable Care Act requires that all wellness and preventive visits be covered, and that they require no co-pay. In this category are not just basic annual physical exams, but regular gynecological exams, chronic disease management visits, domestic violence screening, and maternity and newborn care. Covering preventive and well-patient care keeps costs down for everyone, since health care providers can often find and treat illnesses before they become costly and even life-threatening.
A complaint that many Americans who oppose Obamacare have is that they have to pay for services they don’t need (such as maternity care). In reality, all insurance plans cover services that not every subscriber will need. Covering preventive care, and including maternity and newborn care in that coverage keeps costs down for everyone by reducing the number of emergency room visits, neonatal ICU admissions, and other costly services.
Coverage of pre-existing conditions and wellness visits are the two most widely-known and widely used benefits and protections we’ve gained from the Affordable Care Act. Here are some additional ones that could also disappear with the dismantling of the ACA.
Though the Affordable Care Act expanded the Medicaid program, it also expanded Medicare benefits. One change has been to close the prescription drug “doughnut hole” that left some Medicare recipients, even those with health insurance, with huge drug costs. In addition, the ACA required coverage of more preventive benefits for seniors with Medicare.
Medicare recipients should note that Donald Trump not only wants to do away with the Affordable Care Act, he has also said he plans to eliminate the federal payroll tax. He wants Americans to think he’s giving them a tax break, but it is the payroll tax that helps fund Medicare.
Mental Health and behavioral health treatment
The Affordable Care Act requires insurers to cover mental health care (though often with a co-pay), as well as treatment for drug, alcohol, and other substance abuse issues. It’s notable that the people who want to blame mass shootings on mental health issues rather than on the availability of combat weapons to civilians, are often the same people who are in favor of doing away with the ACA.
Generic biologic drugs
A less-known benefit of the ACA is that it created a pathway for copies of costly FDA-approved biologic drugs, called “biosimilars,” to be available to patients who might otherwise not be able to afford such treatments. These drugs treat serious and life-threatening illnesses such as rheumatoid arthritis, macular degeneration, and cancer.
Before the Affordable Care Act, there was no regulatory pathway for approval of the generic forms of these drugs, and thus, they would have been completely out of the question for many Americans.
Funding to train more health professionals
The Affordable Care Act assumes that if more people have health care coverage, more people will seek health care. Based on this idea, the ACA includes provisions for funds dedicated to training programs to increase the supply of health care providers— including physicians, nurses, therapists, and community health centers.
The Trump administration has a knack for shortsighted, non-strategic actions: the act of separating migrant children from their parents in 2018 without a plan for reuniting them, which resulted in some families being lost to each other to this day; the hasty Muslim ban in 2017 that left many stranded in airports, unable to re-enter the U.S., even with legal visas; the impulsive threat, via tweet, to send missiles to Syria; the many sudden firings of key government officials. The Trump administration’s plan to strike down the Affordable Care Act is just another such impulse without a plan or strategy.
If Donald Trump is successful in doing away with the Affordable Care Act, 29.8 million people in the U.S. would lose their health insurance, according to the Economic Policy Institute. That would more than double the number of people who are currently uninsured. But overturning the ACA would ripple through the economy, resulting in an estimated loss of 1.2 million jobs— and not just in health care.
According to a projection by the Economic Policy Institute, based on 2019, “The combination of tax cuts and spending cuts embedded in ACA repeal would reduce national job growth by almost 1.2 million… all else equal. That is because the spending cuts would hurt job growth more than the tax cuts would help it.”
Many Americans are sick, jobless, and in desperate financial straits as a result of the pandemic and its mismanagement by the same president who now wants to end their access to affordable health care. Though some Americans are oblivious to the impact this will have, it will reverberate through not only our social welfare system, but also our health care system, and what’s left of our economic system, touching nearly all Americans in some way.
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