The ACA – What’s at Stake

The Affordable Care Act (ACA) has been under fire from its inception. Currently the future of the landmark decision and healthcare reform legislation is uncertain. California vs Texas (known as Texas vs U.S. in lower courts) is scheduled to begin oral arguments on Tuesday, Nov.10, 2020. This was sparked by a group of 20 states led by Texas to sue the federal government in February 2018. This case challenges the ACA’s individual mandate which was reduced to zero dollars on Jan.1, 2019 by way of the 2017 Tax Cuts and Jobs Act. The U.S. Court of Appeals for the 5th Circuit affirmed the decision that the individual mandate was no longer constitutional because the individual mandate would no longer produce revenue for the federal government. Instead of striking down the entire ACA, the case was sent back to trial court for additional analysis. The implications for Pennsylvanians and Americans could be disastrous should the law be struck down. Consider:

  • Over 760,000 Pennsylvania Medicaid eligibles would lose coverage
  • Over 307,000 Pennsylvania Health Insurance Marketplace consumers would lose coverage, 87% of those accessing Advance Premium Tax Credits and 44% with cost-saving reductions
  • More than 2.3 million young adults under age 26 nationwide would lose access to coverage through their parents’ group coverage
  • Over 2,105,000 Pennsylvanians with a prevalence of pre-existing conditions could be eliminated from purchasing health insurance
  • 87% of covered workers with employer-sponsored insurance (approximately 133 million people) were enrolled in plans that must provide free preventive services as of 2019
  • Prior to the ACA, 75% of non-group health plans did not cover maternity care, 45% did not cover substance use disorder (SUD) treatment and 38% did not cover mental health services
  • Prior to the ACA, 59% of covered workers’ employer-sponsored health plans had a lifetime limit
  • Prior to the ACA, only 19% of covered workers had no limit on out-of-pocket expenses
  • Reinstating the Medicare coverage gap would increase costs incurred by Part D enrollees who have relatively high drug spending
  • Employers with 50 or more employees must now provide adequate break time for breastfeeding women and a private space that is not a bathroom for nursing and pumping
  • The ACA prohibits discrimination against individuals on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities, under Section 1557, which builds on long-standing and familiar federal civil rights laws

The ACA is an enormous law and the potential impacts of it being eliminated are monumental.