The Affordable Care Act Is Vital To Patients

THESIS

While the Affordable Care Act is considered controversial, and has opposition from many red states, demolishing the act will lead to a serious lack of health care that many americans depend on. The ACA should remain established because the Affordable Care Act is vital to patients access to health care.

SUMMARY

After republican lawmakers have failed numerous times, a group of 20 republican governors and attorney generals are seeking to invalidate the entire healthcare law. They argue that the law no longer can work because last year congress ended a penalty on people who do not have health coverage. Texas and 19 other red flag states have filed the lawsuit, also known as Texas vs. Azar, the case that threatens access to healthcare and coverage for millions of Americans. If victorious, the lawsuit could have a huge affect, successfully stripping health coverage from tens of millions of Americans. The Trump administration has been a patron of the argument being made by the GOP attorneys general, calling for the elimination of provisions of the law prohibiting insurers from turning away sick consumers. The case will be heard in federal district court in Texas. Unfortunately , the federal courts within Texas are among the most conservative in the country, making it feasible the case could move forward.

IDENTIFY THE LEGAL ISSUES

In the article The ACA Remains Critical for Insurance Coverage and Health Funding the authors conducted a study that estimated the effects of a complete revoke of coverage provisions of the ACA. They compared that with insurance coverage and health care spending under current law.( Holahan, Blumberg, Buettgens, 2018)

The current law include the repeal of the individual mandate penalties and other latest policy changes. 12.4 % of the nonelderly population, will be uninsured in 2019. Another 148.7 million people will have employer-sponsored insurance, and 68.9 million people will have insurance through Medicaid or the Children’s Health Insurance Program (CHIP). Close to 14 million people will have nongroup insurance coverage, including those accepting federal tax credits to lower their premiums and those who purchase policies with their own funds.

IMPLICATIONS IF THE LAW IS ENACTED ( FAVOR OF THE ACA)

.If victorious, the lawsuit could have a huge affect, successfully stripping health coverage from tens of millions of Americans According to a new analysis by the Urban Institute, if the ACA is invalidated, more than 17 million people would lose coverage in 2019. This roughly reflects coverage losses over and above the losses associated with setting the individual mandate penalties to $0. If the ACA was invalidated, the number of uninsured individuals would significantly increase to 51.3 million, which is an increase of 50 percent or 17.1 million people. Medicaid/ CHIP admission would fall by 15.1 million through the elimination of the ACA’s medicaid expansion.. ( The ACA Remains Critical, 2018, Para. 8) This is extremely dangerous for low- income population because the level of uninsured low income individuals would increase.

The number of people with private non-group insurance would decrease to 25 percent, from 14.0 million to 10.4 million. Some of those who recently had tax credits would keep non-group coverage, but they would pay the full premiums. Although 3.6 million fewer people would have private non-group coverage, those retaining private non-group coverage would likely have policies that cover fewer benefits and require more out-of-pocket spending for services because of the elimination of the ACA’s minimum benefit and actuarial value standards. These policies would be substantially less accessible to people with current or past health problems because of the elimination of guaranteed issue and modified community rating rules.

Finally, if the ACA were fully repealed, federal spending on acute care for nonelderly people would be substantially reduced. Federal spending on Medicaid and Marketplace premium tax credits would fall from $392.1 billion to $245.5 billion in 2019, a loss of $146.6 billion in federal support to finance health care. This represents a decline of 37.4 percent compared with current ACA-related spending. The decline in federal Medicaid spending alone would total $81.6 billion. The elimination of tax credits would reduce federal spending by $65.0 billion.

Despite the repeal of the individual mandate penalties, and despite the various administrative policy decisions since early 2017 that have reduced insurance coverage and increased premiums in the private nongroup insurance market, roughly 240.2 million nonelderly people will have insurance coverage (either private or public) in 2019 under current law. Without the ACA, the number of insured people would fall to 223.0 million. Medicaid/CHIP enrollment would drop by 15.1 million, and the uninsured would increase by 17.1 million people. States would have less money to support care for people who would lose coverage. These shifts would decrease revenue for health care providers and increase the financial burdens associated with uncompensated care. Thus, invalidating the entire ACA would cause considerable harm, even compared with the ACA as restructured by recent policy changes

ARGUMENTS

The plaintiffs in Texas v.Azar claim that eliminating the penalty ends the individual mandate. They argue that the individual mandate is crucial to the ACA, that the law cannot run or be supported without it, and that, thus, the entire ACA should be eliminated.

Although removing the individual mandate has a harmful impact on insurance coverage, these negative outcomes would only be exacerbated by removing the ACA’s remaining components. Even without the individual mandate penalties, the ACA supports health care in all states with substantial federal dollars. Eliminating the law would significantly reduce investment in Americans’ health. If the ACA was to be entirely repealed, provisions that affect the Medicare program, payment and delivery system reforms, support for community health centers, and preventive care initiatives of the ACA could be completely demolished. The Department of Justice Argument As we were finalizing this brief, the US Department of Justice (DOJ) filed its brief in Texas v. United States, a 20-state lawsuit against the Affordable Care Act.2 DOJ asserts (1) that the individual mandate is no longer constitutional because it is not supported by a tax penalty, and (2) that in striking down the mandate, Congress also effectively struck down the guaranteed issue and community rating provisions, which cannot operate in the absence of the mandate. However, DOJ contends that repeal of the individual mandate penalty does not affect the constitutionality of the rest of the ACA, including the premium tax credits and Medicaid provisions.

DOJ argues that Congress would not maintain the guaranteed issue and community rating provisions without the mandate because the markets could not function with those provisions but without the mandate. But a recent Congressional Budget Office report showed that although the number of uninsured people and the cost of premiums would rise without the mandate, the Marketplaces could still function (CBO 2018). Urban Institute modeling reached the same conclusion, as shown in this brief’s estimates of coverage and government spending. In table 1, the “current law” scenario reflects the ACA without the individual mandate but with guaranteed issue and community rating. If DOJ’s position were adopted, insurers could deny coverage to anyone and could charge higher premiums to the sick. This does not seem to be Congress’s intent; although it repealed the tax penalty for the individual mandate, it has not eliminated guaranteed issue and community rating provisions. And if those provisions are eliminated, it is not clear how benchmark premiums for Marketplace tax credits would be determined, or how those tax credits would be delivered to eligible enrollees

WHAT COMES NEXT

Judge O’Connor is expected to rule on the plaintiffs’ request for a preliminary injunction and said he hoped to do so “just as quickly as I can.” He could uphold the ACA entirely, strike down only the individual mandate, strike down the individual mandate and other provisions that he deems to be inseverable from the mandate, or strike down the entire ACA. He could also limit an injunction to only those states that brought the lawsuit, or impose it nationwide.

All parties expect any ruling to be immediately appealable. The intervenor states asked the court to stay an injunction pending an appeal or, at a minimum, extend a stay for a limited period of time to allow the states to seek a separate stay by the Fifth Circuit Court of Appeals.

This lawsuit could be the most dangerous effort to destabilize the American healthcare system yet. That’s why the American Public Health Association has submitted friend-of-the-court briefs opposing this suit, along with many other health organizations, insurers, economists and members of the business community. (Benjamin, 2018)

Instructions: Research pending legislation (state or federal) or a pending court case (appellate or supreme court) that relates to health care. Identify the legal issues. Discuss the implications if the law is enacted or if the case is decided in favor of one side or the other. Your paper should be 5-8 pages, not including title page and references. It is to be submitted to Turnitin in either Word or pdf format. It is to be completed in APA style and format and must include at least 3 research-based articles to support your thesis. The thesis statement must be highly developed and the rest of the paper should address the thesis. You will be graded on the ability to use examples that support the thesis statement.