Wash. Gov. Inslee: State Leaders Warn U.S. Senators of Pending ACA Lawsuit Amid Supreme Court Nomination

OLYMPIA, Washington, Oct. 16 -- Gov. Jay Inslee, D-Washington, issued the following news release:

As the U.S. Senate rushes through the nomination of Judge Amy Coney Barrett, the lawsuit deciding the fate of Affordable Care Act (California v. Texas) will be heard by the U.S. Supreme Court in less than a month -- putting the future of the popular law and the health care of millions in serious peril.

If the court overturns the Affordable Care Act, the impacts to Washington state would be widespread and devastating. Despite the state's efforts to enact many of the ACA protections into Washington state law, overturning the ACA would be financially catastrophic to the state and its residents. It would be especially damaging as Washingtonians continue to battle the COVID-19 pandemic.

In a letter to Washington's U.S. Senators, Gov. Jay Inslee, Insurance Commissioner Mike Kreidler and Washington Health Benefit Exchange CEO Pam MacEwan detailed what's at risk in the highly anticipated court case.

They laid out that if the Affordable Care Act is overturned, Washington state will lose $4.2 billion annually in federal funds and more than 750,000 could lose coverage.

* $3.6 billion cut in annual federal funding to pay for Medicaid expansion coverage as 625,000 newly eligible enrollees would lose health coverage.

* $620 million cut in federal premium subsidies as 140,000 people lose the financial assistance that helps them afford health insurance.

"That a decision could be made in the midst of the COVID-19 pandemic and our nation's ongoing efforts to recover only intensifies the harm. More than 90,000 Washingtonians will have a new pre-existing condition this year after having been diagnosed with COVID-19," the leaders wrote. "This would have massive implications for people who rely on the law's reforms, such as women and older adults. A court decision that makes coverage unaffordable for many would effectively undermine these consumer protections and erode the safety net we have fought to preserve."

State leaders acknowledge that these are federal decision and urged members of Congress, particularly U.S. Senators, to continue fighting to protect the health and well-being of Washingtonians."

* * *

To: The Honorable Patty Murray, United States Senate, 154 Russell Senate Office Building, Washington, D.C. 20510

The Honorable Maria Cantwell, United States Senate, 511 Hart Senate Office Building, Washington, D.C. 20510

Dear Senators Murray and Cantwell:

As the U.S. Senate rushes through the nomination of Judge Amy Coney Barrett, less than a month before the U.S. Supreme Court takes up the California v. Texas lawsuit over the Affordable Care Act (ACA), we are writing to share with you our very serious concerns for Washingtonians if the law is struck down by the Court -- as advocated by the Trump administration's own Department of Justice. We appreciate your tireless work to protect the ACA from relentless attacks over the last decade and we know you share our concerns about this pending case. The stakes could not be higher.

That a decision could be handed down in the midst of the COVID-19 pandemic and our nation's ongoing efforts to recover only intensifies the harm. More than 90,000 Washingtonians will have a new pre-existing condition this year after having been diagnosed with COVID-19.

Since enactment of the ACA, more than 800,000 people gained coverage through the Washington Health Benefit Exchange and Medicaid expansion -- cutting our uninsured rate from 14 percent to 5.5 percent in 2019. For hundreds of thousands of Washingtonians, that coverage has persisted despite any losses of employment that occurred due to the pandemic. We have succeeded in embedding many of the ACA's protections into state law, but we cannot inoculate our people or our economy from the irreparable damages if the law is struck down. It is hard to comprehend how a decision of this magnitude could be made during a global public health crisis that is unlike anything we have seen in our lifetimes.

If the Supreme Court overturns the ACA, the impact on the country and our state will be widespread and devastating. Washington State alone stands to lose billions of dollars in annual federal funding that directly finances affordable health coverage for working families -- a cost so high it cannot realistically be assumed by the state -- while depriving more than 750,000 of our residents of affordable health care coverage, critically damaging our state's economy, and destabilizing our insurance markets. As our state faces historic declines in revenue, the ramifications of such a decision are well beyond our capability to prevent.

If the Affordable Care Act is struck down we will see:

* Elimination of coverage for 625,000 residents who became newly eligible for Medicaid under the ACA, at a cost of $3.6 billion annually in lost federal funding.

* Elimination of financial help and likely loss of coverage for 140,000 residents who currently receive federal subsidies to purchase qualified health plans on the Exchange, at a cost of $620 million in 2019 in lost premium tax credits under ACA.

* A total loss of over $4.2 billion annually in federal funds for residents across the state who currently receive free or low-cost coverage under the ACA.

Because of state action, consumers in Washington state are protected from annual and lifetime caps, excessive waiting periods, pre-existing conditions exclusions, and discrimination based on gender, race, national origin or disability. The structure and responsibilities of the Washington Health Benefit Exchange are now in state law.

However, a decision overturning the ACA would render many of these protections useless for the hundreds of thousands of Washingtonians that could be thrown off their health plans. The ability to obtain coverage without consideration of pre-existing conditions, and with guaranteed basic and essential health benefits, provides no protection for Washingtonians who simply cannot afford the coverage. This would have massive implications for people with pre-existing conditions and others who rely on the law's reforms, such as women and older adults. A court decision that makes coverage unaffordable for many would effectively undermine these consumer protections and erode the safety net we have fought to preserve.

The Affordable Care Act is critical to providing health care during the pandemic.

During these times of public anxiety about the virus, Washingtonians should not have to worry about health insurance coverage. They need to know they have access to high quality, affordable medical care. Unfortunately, as COVID-19 has harmed our economy, thousands of people have lost their job and, along with it, their health insurance.

We know the pandemic has already caused more than 100,000 of our fellow Washingtonians to lose health coverage this year. As of September 2020, our state's uninsured rate had grown back to eight percent -- and the impact among newly unemployed people has been disproportionately high. With the loss of ACA-based health insurance, the uninsured rate would likely skyrocket higher than it was before 2013.

Thankfully, our Health Benefit Exchange took immediate actions in response to COVID-19 to help connect Washingtonians to health coverage under the ACA. It was the first in the nation to open a special enrollment period for people newly uninsured because of the pandemic. Our state agencies worked in partnership with community partners and employers to reach this population and let them know about their coverage options, and more than 22,000 people signed up for coverage over a two-month period. Enrollment under Medicaid expansion in our state has also increased by nearly 80,000 since the COVID-19 pandemic began and our efforts to assist the uninsured are ongoing. None of this would have been possible without the ACA.

People of color have been disproportionately impacted.

A quarter of the individuals who enrolled in coverage through our Exchange during the special enrollment period are black, indigenous or people of color. We have also seen many disparities in COVID-19 infection, hospitalization and deaths among people of color and indigenous people:

* Our Hispanic state residents have infections rates three times their representation in our population;

* Hospitalization among Native Hawaiian and other Pacific Islander peoples is four times their share of our population; and

* Deaths among Native Americans and Alaska Native residents of our state are three times their percentage of our population.

We are working to address the many disparities, but the ACA is integral to this work.

Critical coverage and essential health benefits are needed during the pandemic.

As we are seeing increased use of behavioral health services during the COVID-19 pandemic, the coverage of mental health and substance use disorder (SUD) treatment offered by the ACA ensures life-saving care for Washingtonians who need it most. Since 2014, more than 112,000 Washingtonians newly eligible for Medicaid have accessed SUD treatment and more than 325,000 have received mental health services.

The ACA means more than just access to medical and behavioral health services. Some of the adults in our Medicaid expansion population also require rehabilitation in a nursing facility after an acute hospital stay and others with behavioral health challenges have sought help with activities of daily living. Many of these adults needed these services provided through nursing facilities, adult family homes and at home -- and have received care as a direct result of the law.

Confirmation of Judge Barrett carries grave consequences.

All Washingtonians deserve affordable, quality health coverage. We have made amazing strides toward this goal under the ACA. Yet the California v. Texas lawsuit threatens to wipe out our progress and endanger the lives of our neighbors, friends and family. Given that President Trump has publicly committed to nominating judges who will "terminate" the law, his administration's explicit support of this lawsuit, and Judge Barrett's own record questioning previous U.S.

Supreme Court decisions upholding the ACA, we are gravely concerned that a vote to confirm Senators Patty Murray and Maria Cantwell her to the Court would be a vote to repeal health care for hundreds of thousands of our people.

We ask that you continue fighting with us to protect the health and well-being of our state.

Sincerely,

Jay Inslee, Governor

Mike Kreidler, Insurance Commissioner

Pam MacEwan, CEO, Health Benefit Exchange

Enclosure: Detailed list of consumerprotections in the ACA and the associated protections now

embedded in our state law.

Tables can be found here: https://www.governor.wa.gov/sites/default/files/GOV%20OIC%20HBE%20SCOTUS%20Delegation%20Letter.pdf