ACA Turns 10 Amid Challenges From COVID-19 And Court Case

Monday marks the 10-year-anniversary of the Affordable Care Act, which has provided medical insurance to more than 20 million people and may play a crucial role for those needing hospitalization during the coronavirus crisis.

State officials have ordered schools and nonessential businesses to close, resulting in hundreds of people losing their jobs and health insurance plans.

It may also cause an enrollment increase in the marketplace established by former President Barack Obama’s health care law because lower wage workers qualify for the biggest financial assistance for health insurance, Kaiser Family Foundation Executive Vice President Larry Levitt said in a media briefing Wednesday.

Typically, medical assistance programs, such as Medicaid, see enrollment increases during economic downturns.

“We may very well be in a recession or headed to a recession,” Levitt said. “And this would be the first recession since the Affordable Care Act went into effect, so we are in uncharted territory in terms of what might happen in a recession under both the ACA marketplace and the Medicaid expansion.”

“Obamacare,” as the law is often known, allows people who lose their insurance or income to sign up any time in the year. The program covers a portion of the cost of the premiums, deductibles and copays for most people. The financial assistance is proportional to income, so people with less income get more financial assistance. A national survey conducted March 13-14 showed that nearly 1 in 5 people said they’ve lost their jobs or suffered cuts to working hours.

Access to health care has been top of mind for many Americans as the coronavirus spread throughout the United States, infecting more than 32,000 and killing more than 400 people. Coronavirus cases, which first appeared in December in China, are already affecting hospitals with limited protective equipment. Some governors ordered thousands of extra beds built to accommodate a surge in seriously ill patients who will need them. They also will need breathing machines, which hospitals typically have few of.

“Having coverage and access to care is now essential to people in ways that weren’t before the outbreak," said U.S. Sen. Bob Casey, D-Pa., a vocal supporter of the ACA.

Last week, Pennsylvania Gov. Tom Wolf asked federal health officials to allow anyone who may be uninsured or underinsured to enroll in Obamacare plans for 60 days, not just people with life-changing circumstances like a job loss. Some states that run their own Obamacare marketplaces reopened enrollment. Pennsylvania, which will run its own next year, isn’t set up to do that now.

While there is a federal mandate to protect people against evictions and there are proposals in Congress to provide paid sick time for affected workers, there’s no policy or proposal to allow people to delay insurance payments. However, the state Insurance Department asked insurance companies to be lenient with people who can’t make premiums because of job loss or pay cuts from the statewide business shutdown.

The state suggested relaxing dates for premium payments, extending grace periods, waiving late fees and penalties and doing whatever possible to ensure people do not lose coverage.

Without insurance, the average cost for a hospitalized coronavirus patient could be anywhere from $10,000 to more than $20,000, according to a Kaiser Family Foundation analysis. And even with insurance, the cost likely will be in the thousands because so many plans have high deductibles and copayments.

Despite the high out-of-pocket costs, Pennsylvania Insurance Commissioner Jessica Altman noted people are better off with insurance.

“That’s still a really big difference in responsibility, between a $4,000-$5,000 deductible for a lower tiered plan and facing the full brunt of the $20,000 hospital stay,” she said.

Obamacare has been politically volatile since Obama signed it into law March 23, 2010. It survived a Supreme Court ruling that almost killed the law at the outset, suffered through a disastrous rollout hobbled by technology problems, followed by a period of skyrocketing premium costs, legal challenges and then a Republican administration bent on eliminating the program.

The law’s future could hinge on a fresh case that the Supreme Court has agreed to hear, which challenges the constitutionality of the ACA.

While Democrats have been fighting to preserve Obamacare, the left wing of the party has shifted focus to broader health care ideas, such as “Medicare for All.” The universal health care platform has gained support among Democrats in recent years, despite the lack of a clear political or financial path forward.

ACA enrollment has declined in the last few years, as premiums went up and the Trump administration removed a mandate requiring people to get health insurance or pay a penalty. Healthier people with lower incentives to get insurance slowly left the marketplace as prices shot up because of the high cost of treating chronically ill patients who previously lacked insurance. Eliminating the mandate made the choice easier for younger people.

However, the coronavirus may be changing attitudes for some, Altman said.

“With everything we’re thinking about, everyone has health front of mind. Insurance coverage is one of the ways they can protect selves and families with coronavirus or anything else,” she said.

Obama’s signature law transformed health care in America, Casey said, pointing to people gaining coverage despite having preexisting conditions, Medicaid expansions that covered hundreds of thousands of Americans, free preventive health coverage, and family coverage for young people under 26.

Casey said lawmakers need to work to bridge the gap, so people aren’t asked to pay so much out of pocket that it’s a disincentive to signing up.

“In the near term, we need to make sure we can protect what we can,” he said.

Morning Call reporter Binghui Huang can be reached at 610-820-6745 or [email protected].

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