By Christiana Silva
The health and safety of American citizens is as precarious as ever. The appointment of Amy Coney Barrett as Justice Ginsburg’s replacement puts the future of the Affordable Care Act (ACA) at risk. In response to Democratic fears about the pending Supreme Court challenge to the ACA, Barrett suggested during her nomination hearings “I am not here on a mission to destroy the ACA.” However, the Supreme Court may do just that if it (with Barrett as a likely critical vote) strikes down the law by deciding in California v. Texas that the ACA’s individual mandate is unconstitutional. Without the mandate, the ACA will be unable to exist, and millions of Americans will suffer the consequences.
One of the policy pillars of the ACA, the individual mandate requires individuals to purchase health insurance or pay a monetary penalty. This incentivizes young, healthy adults to buy insurance, to cover the cost of the older and sicker population. Congress repealed the monetary penalty when it passed the Tax Cuts and Jobs Acts in 2017, however the repeal of the penalty further complicates the ACA’s fate because although the federal government no longer enforces the penalty, the mandate remains in effect and many of the other ACA provisions are reliant on it.
Without the ACA, the nation’s health care system will take a massive toll, the individual market will be disturbed, costs will increase, and millions of Americans will lose coverage. According to the Kaiser Family Foundation, an estimated 54 million people with pre-existing conditions would be denied coverage if the ACA were not in effect. In addition, all of the provisions that are enforced by the ACA including protections for people with preexisting conditions, essential health services, family coverage for young adults until the age of 26, and preventive services will likely disappear. Many Americans will be left vulnerable and unprotected without them.
The nonpartisan Congressional Budget Office predicts that insurance premiums will increase by ten percent over the next ten years if the ACA were struck down. For those who use health care services the most, prices will skyrocket and leave many paying astronomical amounts to receive necessary care. Young and healthy Americans might opt out of their insurance if there is no incentive to have it, risking the potential of paying for expensive care if they were to get sick. According to the American Medical Association, eliminating even certain provisions, not just the entire ACA, would have a devastating impact on doctors, patients, and the American health care system in normal times.
The Trump administration and many Republican-led states insist on repealing the ACA in its entirety. They argue that repealing the act will save the country money and reduce federal deficits by as much as $338 billion. This is where we have to make a choice: is it more important to save millions of dollars or to save millions of lives?
Repealing the ACA means the absence of free preventive services. The U.S. Department of Health and Human Services estimates that approximately 137 million people have received preventive services gratis since the implementation of the policy. Without free preventive services, many Americans will forgo necessary screenings and will be unable to treat disease and illness in its early stages.
Critics of the ACA strongly believe that being required to purchase health insurance violates their constitutional rights. However, they fail to acknowledge that the individual mandate allows for more freedom in the sense that it provides health security and in turn, financial security. Republicans continue to disparage the ACA but offer no valid replacement. Since his initial campaign in 2016, President Trump has continued to promise Americans a less expensive alternative to the ACA, but prices have continued to rise during his administration and he has failed to introduce, let alone implement, his health care reform. During his campaign he stated, “you’ll have great health care at a fraction, a fraction of the cost and it’ll be great”. But without a clearly articulated alternative, millions of Americans stand to lose the health and financial security offered by the ACA.
Although the ACA has its flaws, it has changed American lives for the better by ensuring that millions of Americans have access to affordable, high quality health care. According to the National Bureau of Economic Research, since the ACA’s passage, 20 million uninsured Americans gained coverage and seniors saved over 20 billion dollars on prescription drugs. The Trump administration must be stopped from sabotaging the future of health care for millions. The appointment of Amy Coney Barrett to the Supreme Court could be detrimental to health care as we know it, unless she votes to uphold the ACA or at a minimum, sever the question of the constitutionality of the mandate from the ACA itself. When asked to clarify her stance on severability, Barrett stated that judges can presume that a larger part of a law can be saved even when part of it is constitutional: “I think the doctrine of severability serves a valuable function of trying not to undo your work when you wouldn’t want a court to undo your work.” Our country will be watching to see if she stands by her words, or whether she will vote in a partisan fashion to gut the ACA and change American health care for the worse.
Christiana Silva, a resident of Pelham, New York, is a junior health policy and management major at Providence College.
