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Legal challenges to ACA could put millions of Americans at risk of losing health insurance A potentially profound impact

By Steve Metsch

Legal challenges to the Affordable Care Act, or ACA, could have a devastating impact on the health and well-being of millions of Americans, according to studies by Highmark. Citing a report by the Urban Institute/New York Times, if the ACA is struck down in court — as the Trump administration has been attempting for the past four years — 21 million Americans could lose their health insurance. The study said that 12 million adults who gained access to Medicaid through state expansion could lose coverage, and some 133 million Americans with pre-existing conditions — or roughly half the population younger than 65 —would lose protections. In addition, the study reports that 2 million young adults would be forced off their parents plans if the ACA is struck down. The study found that if the ACA is repealed, states that ex- panded Medicaid and/or had a high marketplace participation would feel the largest relative increase in uninsured population. Pennsylvania is among those states. According to Highmark, a variety of health programs would lose authorization with repeal of the ACA. Some of those include: limiting customers’ financial protec- tions; changing the formula used to calculate providers’ Medicare payments; eliminating the provision requiring pharmaceutical companies to disclose gifts and payments to physicians; ending the requirement of chain restaurants to publish calorie informa- tion on menus; invalidating insurance coverage of breast pumps and not requiring rooms for nursing mothers; and increasing drug costs for Medicare users. According to The Commonwealth Fund, the ACA faces a re- newed threat, as a Texas federal court judge is hearing arguments in a case that seeks to invalidate the law’s pre-existing condition protections, and potentially the law itself. This latest lawsuit asserts that Congress’s repeal of the individ- ual mandate penalty has rendered the mandate unconstitutional.

Further, it states that the mandate is an essential feature of the ACA and that without it the rest of the lawmust be struck down, too. Should this argument prevail, an estimated 17 mil- lion people could become uninsured, a number slightly lower than the previous estimates, but still very large. However, even with a new 6-3 conservative majority on the Supreme Court, usnews.com reported on Nov. 10 that the ACA may not be endangered after all. Two conservative justices, including Chief Justice John Rob- erts, indicated that they were unlikely to scrap the entire law, even if the individual mandate is deemed unconstitutional. Lisa Hagen of usnews.com reported: “During two hours of oral arguments in the landmark case, the justices, including newly installed Justice Amy Coney Barrett, weighed the constitutionality of the individual mandate – the requirement that people purchase health insurance or pay a penalty that Congress eliminated in 2017. “Republican Attorneys General, supported by the Trump ad- ministration, believe the mandate should be struck down and, because it was once seen as a critical part of the law, the rest of the ACA cannot stand and should be entirely invalidated. “Democratic-led states and an attorney for the U.S. House, meanwhile, argued that Congress “made a single surgical change” when reducing the penalty to zero while the rest of the law’s provisions were kept intact. “California Solicitor General Michael Mongan asked the court not to ‘tear down’ the law and asserted that there is a ‘strong presumption in favor of severability,’ meaning that a provision like the mandate can be removed from the law and the rest of the statute could still stand on its own,” the story states. A decision on the challenges to the ACA is expected from the Supreme Court no later than June 2021, according to High- mark.

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