Democratic politicians have voiced serious concerns over the recent confirmation of Amy Coney Barrett to the US Supreme Court. One of the main issues of contention is the Affordable Care Act (ACA), also known as ‘Obamacare.’ Barrett is known to be critical of the ACA in her past writings.
Now that Barrett has been confirmed, the balance of the Supreme Court lies heavily in favor of the conservative judges. The first case for Barrett will be the much-debated ACA case, with hearings having begun on November 10. Many are watching this case closely as the threat of striking down the ACA could have huge implications for American individuals and businesses alike.
What Does a Joe Biden Presidency Mean for the Affordable Care Act?
At the time of this writing, The Associated Press has declared Joe Biden as the next president of the United States. Even though several states are still counting ballots and the Trump administration is in the midst of launching lawsuits, it appears highly unlikely Trump will upend Biden as the next president of the United States. With Biden winning the 2020 US elections, there is no question where Biden stands on the issue of the Affordable Care Act. After all, it was Biden who was at Obama’s side when he signed off on the ACA in 2010.
A Biden administration promises not only to protect the ACA but to further expand and build on it. Although a Republican-controlled Senate would complicate things, there are certain actions Biden can take to bolster the ACA.
These actions could mean implementing operational changes, such as announcing an immediate special enrollment period for those without insurance on the Health Insurance Marketplace. It could also mean reversing many of the Trump administration policies that make it difficult for citizens to enroll in the ACA coverage. Biden could even go as far as using the executive branch authority to further promote the ACA.
Potential Options for the Supreme Court
While certain actions can be taken by the Biden administration, the fate of the ACA is ultimately not in the administration’s hands, but that of the Supreme Court. After a complicated history of litigation, the constitutionality of the ACA has been challenged by a number of states over the years.
These challenges have led to where we are today. On November 10, The Supreme Court began its hearings on whether the ACA is constitutional in California v. Texas. At the heart of the case is the “individual mandate” provision of the ACA. This mandate forces Americans without healthcare insurance to pay an income tax penalty. With the elimination of the individual mandate provision through President Trump’s Tax Cuts and Jobs Act of 2017, Republican-backed state attorneys are now arguing that the entire ACA is unconstitutional.
As the Supreme Court begins its deliberations, legal experts have identified a few possible options the Supreme Court can take:
- Dismiss the case on technical grounds while upholding the ACA
- Uphold the ACA as constitutional
- Uphold the ACA as constitutional and finding the individual mandate void without its penalty (i.e. maintaining the status quo)
- Void the individual mandate as well as other provisions close to it while still upholding the remainder of the ACA
- Strike down the entire ACA in full
Even with the recent addition of Barrett, most legal experts believe the chances of the Supreme Court striking down the entire ACA in full is unlikely. Taking down the entire ACA would be extremely disruptive to the system, especially considering the present pandemic Americans are still facing. Even if the courts rule in striking down the ACA, Congress would still have the opportunity to correct parts of the law that were deemed unconstitutional. Alternatively, they could also push through new healthcare legislation.
What Will Happen if the Supreme Court Strikes Down the ACA?
Many are asking the question, “What will happen if ACA is struck down?” If the Supreme Court does decide to strike down the ACA, most agree there will be significant impacts. These impacts will not only be felt by individuals but by healthcare providers and businesses alike.
Here are some potential consequences to healthcare providers and businesses if ACA is indeed struck down.
Restructuring of Employer Plans
Currently, under the Affordable Care Act, employers must offer health insurance to their employees under the “Employer Mandate.” If the courts strike down the ACA, employers may consider restructuring their plans to reduce costs. This will mean potentially less coverage for their employees.
For instance, common provisions of the ACA, like dependent coverage till the age of 26 or protections for those with preexisting conditions, may be scrapped or modified by employers. They may consider full-time employees as those working 40 hours, rather than the 30-hour provision mandated by the ACA.
Healthcare Providers Losing Revenues
If certain aspects or all of the ACA provisions were to be struck down, many healthcare providers, hospitals, and doctors could lose a significant source of revenues. Those with preexisting conditions could once again be denied coverage by insurance companies. Lower income individuals would also find it difficult to afford insurance.
Additionally, a study by The Commonwealth Fund found that through Medicaid’s expanded reach, the burden of uncompensated care lessened on hospitals, thereby lowering their operating costs. The study finds that state hospitals involved in the ACA’s Medicaid expansion saw estimated savings of $6.2 billion. The striking down of the ACA could potentially increase the burden of uncompensated care in hospitals resulting in increased cost and negatively impacting their bottom line.
Loss of additional provisions
Other not as well-known provisions could be lost or void. For example, the ACA has provisions for “reasonable break time” for nursing mothers to pump milk for their child during work. Retail food establishments are also required to list calorie counts on their menus under the ACA. These and more provisions could be lost without the ACA.
As mentioned, most political and legal pundits view the chances of a complete Affordable Care Act strike down as highly unlikely. However, even the dismissal of certain provisions of the ACA can have significant implications for businesses. Americans will be watching closely as the case unravels in the upcoming months.
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