Congress Considers Expanding ACA As Feds Move to Dismantle It

The House of Representatives voted to expand the Affordable Care Act only days after the White House reiterated its resolve to dismantle the Affordable Care Act altogether.

The House of Representatives passed the bill by a highly partisan vote of 234 in favor and 179 against.

If the bill were to become law in its present form, it would establish an Improve Health Insurance Affordability Fund. States could draw from the fund for two purposes. The funds could go toward:

• Reinsurance payments in the individual health insurance marketplace
• Reducing out-of-pocket healthcare spending for members in qualified health plans on the individual health insurance market

However, the bill is unlikely to make it very far in the Republican-controlled Senate.

Four days before the House of Representatives voted, the Trump Administration filed a brief to the Supreme Court reiterating its stance against the Affordable Care Act. The Supreme Court agreed to review the Affordable Care Act’s constitutionality in March 2020.

The argument of the brief followed much of the same logic that the executive branch has voiced for the past year. It focused on the three questions of the case: the participants’ standing, the individual mandate’s constitutionality, and the Affordable Care Act’s overall constitutionality.

“The entire ACA thus must fall with the individual mandate, though the scope of relief entered in this case should be limited to provisions shown to injure the plaintiffs,” the federal brief argued.

However, any mention of “coronavirus,” “COVID-19,” or “pandemic” was notably lacking. The brief’s silence on how dismantling the Affordable Care Act would affect patients in the present crisis fueled critiques.

“If President Trump gets his way, 130 million Americans with pre-existing conditions will lose the ACA’s lifesaving protections and 23 million Americans will lose their health coverage entirely,” Speaker of the House Nancy Pelosi (D CA) said in a statement.

“There is no legal justification and no moral excuse for the Trump Administration’s disastrous efforts to take away Americans’ health care.”

The White House has stated that any replacement will depend upon the court’s decision.

“We have planned for a number of different scenarios but we need to hear from the courts,” CMS Administrator Seema Verma told the House Committee on Energy and Commerce in October 2019. “The President has made clear that we will have a plan in action to ensure that Americans maintain access.”

The debate continues as unemployment declined to 13.3 percent in May 2020 following a record high 10.3 percentage point increase in April 2020 to hit 14.7 percent.

As the unemployment rate fluctuates, states with their own enrollment platforms have been leaning into their Affordable Care Act marketplaces to pick up the uninsured.

By opening a special enrollment period and increasing marketing, California saw a 250 percent higher signup rate than its 2019 special enrollment period signup, Connecticut saw 70 percent higher enrollment, and the District of Columbia’s enrollment rose 66 percent.

Recent data also showed that 14 million workers in hard-hit industries are eligible for an Affordable Care Act plan, Medicaid, or the Children’s Health Insurance Program (CHIP). For these workers, the Affordable Care Act plans could form a critical health insurance safety net.

However, eligibility does not necessarily equal access, a Sidecar Health survey indicated. For nearly three-quarters of the respondents (74.1 percent), healthcare costs were a major barrier to gaining insurance.

Although 84 percent were concerned about the fact that they had no healthcare coverage, there was slightly more anxiety about health insurance costs (86 percent).

Payers and payer organizations like America’s Health Insurance Plans (AHIP) have been vocal in their support of the Affordable Care Act as the marketplaces are beginning to teem with more payer options for consumers to consider.

The court will likely hear the case for the Affordable Care Act’s constitutionality in the fall of 2020 with a final decision expected in 2021.