Opinion: Let’s Hear Democrats’ Plans If ACA Is Overturned

By The Herald Editorial Board

Among the more common focal points for the series of forums among the dozen or so Democratic debates this year have been Americans' access to health care, and in particular, how to provide and pay for it. That line of questioning continued Wednesday night in Atlanta with the latest clashes over Medicare for All and its alternatives.

No doubt, the cost and availability of health care are of prime concern for Americans, but — at least for the early months of the run for the Democratic nomination — the issue has mostly served to provide the easiest path for candidates and the media to define individual differences on the issue and where the candidates fall on the moderate-to-progressive spectrum.

On the progressive end you find Sens. Bernie Sanders, I-Vermont, and Elizabeth Warren, D-Massachusetts, advocating for Medicare for All. On the moderate end sit South Bend, Indiana, Mayor Pete Buttigieg and former Vice President Joe Biden, both wary of requiring people to leave private insurance plans for a single-payer system.

These forums are the place for such debate; the discussion of how to best provide adequate health coverage and care is vital to the physical health and economic stability of families, and the nation, itself. But, for a change, that long-range debate is overshadowing more immediate concerns; at least they should be more immediate.

Sometime in the coming weeks or months, the 5th Circuit Court of Appeals in New Orleans is expected to issue its ruling in U.S. vs. Azar, appealing a judge's decision for the U.S. District Court in Texas, one that challenges the constitutionality and the continued availability of the Obama-era Affordable Care Act. The lawsuit was the most recent attempt to end what is also known as Obamacare after a Republican-controlled Congress failed to repeal and replace the program.

Finding in favor of a coalition of Republican state attorneys general and governors, Judge Reed O'Connor ruled last December the entirety of the Affordable Care Act as unconstitutional. O'Connor determined that because Congress had earlier repealed the ACA's tax penalty for those who declined to obtain health insurance, the entire law was thus unconstitutional. O'Connor later issued a stay while the case was on appeal.

Regardless of the outcome in the 5th Circuit, the case is nearly certain to come before the U.S. Supreme Court next year.

If the ACA is ultimately struck down, it will leave a life-threatening crisis in the hands of Congress and the White House, regardless of whether Democrats or Republicans are in control.

Up to 20 million Americans would lose the health care plans they have gained under the ACA and the expansion of Medicaid in a number of states, including Washington state.

Popular provisions of the ACA also would be lost, including rules that require insurers to offer coverage to adults up to age 26 through their parents' insurance; prohibitions of annual and lifetime coverage limits and the loss of caps on out-of-pocket costs; and guaranteed coverage for those with pre-existing conditions. About 130 million Americans younger than 65 live with pre-existing conditions that — without the protections of the ACA — would expose them to higher-cost insurance premiums or loss of coverage all together.

Even in the face of opposition and attempts by the Trump administration to undermine it, the ACA has gained in support and in stability in recent years. After years of unpopularity among most Americans in polls, since April 2017 its popularity in a Kaiser Family Foundation tracking poll has trended upward with about 52 percent "favorable" to 41 percent "unfavorable."

Another KFF poll found that 57 percent of Americans polled were worried that someone in their family would lose health insurance coverage if the Supreme Court overturns the ACA.

With annual enrollment in the ACA now continuing until Dec. 15, about 930,000 have signed up for coverage, even as the Trump administration has drastically cut the program's outreach and marketing budget to about a tenth of the funding that was provided during the Obama administration.

At the same time, those enrolling are finding that insurance premiums through the ACA's marketplace are about 4 percent cheaper this year, its second decrease in as many years.

The back-and-forth among Democrats over Medicare for All, a public option and other reforms necessary to lower costs for medical care and prescription drugs are necessary discussions. But, in particular for Medicare for All, that debate needs to be tempered with some reality.

For Democrats, passage of such a landmark change in health care as Medicare for All would require more than just winning the White House, or even maintaining control of the House and winning a majority in the Senate. The Senate would have to experience a blue wave that would flood it with a filibuster-proof majority.

As informative — and defining — as the Medicare for All debate is, a few moments spent by the candidates and debate moderators on how to respond if the ACA is overturned or how it can be improved upon would be equally helpful as voters consider who they will support.