Since its proposal in 2009, the Affordable Care Act (ACA) has been responsible for countless hours of debate and controversy by pundits, politicians, and political analysts. The goal of the bill was to expand health insurance to some of the millions of Americans who go without it each year and to reduce federal spending on healthcare in the long run. However, because of congressional and judicial attacks, the ACA’s future remains unclear. While the bill may currently remain on unsure legal footing, it is clear that Congress cannot allow the ACA merely to dissolve without a replacement.
The ACA, or Obamacare as it is more often known, helped to create online exchanges through which private insurance could be purchased, and it also offered large subsidies to pay for premiums for many Americans. The law requires employers to cover preexisting conditions, prohibits lifetime and annual coverage limits, and encourages states to expand Medicaid. It also planned to help create a reduction of federal spending in Medicare and Medicaid through the expansion of affordable opportunities to the public. If more people bought insurance through the online exchange, increased options should drive down insurance plan costs. The government would have to put fewer tax dollars toward healthcare costs if more people who suffered injuries or illnesses had coverage.
However, there are many aspects to the bill that have made Obamacare intensely unpopular within the Republican party. A temporary increase in government spending, requirements for businesses to provide coverage for birth control products, and the individual mandate, which imposes a tax on Americans who do not have health coverage as an incentive to try and increase the number of people who are covered, have been the biggest talking points over the years. After a rocky road to passage in Congress, one that involved 25 days of consecutive session in the Senate and over 500 proposed amendments, Obamacare was immediately challenged by Republicans and its provisions were placed on hold as the case reached the Supreme Court. Yet, Obamacare was upheld. In the 2012 case King v. Burwell, it was determined that the individual mandate was constitutional because it was a “valid exercise of Congress’ right to tax.”
But Republicans have still been fighting to get rid of Obamacare since their defeat in the Supreme Court. In 2013, because of efforts to avoid appropriating funds for its execution at the beginning of 2014, as well as arguments about raising the debt ceiling, Republicans forced a government shutdown for 16 days. After gaining control of both houses of Congress and the White House in the 2016 elections, Republicans attempted to draft their own healthcare plan to replace Obamacare. However, it was rather unpopular, with one national poll showing only a 17 percent approval rating, and Republican leadership eventually ceased their efforts.
Although they failed to repeal Obamacare during their two-year period of one-party control of the federal government, Republicans were able to pass the GOP tax bill in December 2017. Within the text of this bill, there was a repeal of the individual mandate of the ACA, which had been one of the most hated portions. While this won’t affect many Americans currently, the mandate had served as an effective incentive to get people to pay for healthcare. According to the Congressional Budget Office (CBO), because of the repeal of the mandate, an estimated 13 million fewer Americans will have healthcare in 2027 than what the number would be if the mandate remained part of the ACA. Additionally, premiums are expected to increase 10 percent on the open market by 2021.
While this mandate repeal could lead to a growing percentage of Americans without health coverage, the repeal had more drastic and direct consequences. This past December, federal district judge Reed O’Connor from Fort Worth struck down Obamacare, declaring it unconstitutional. In his opinion, O’Connor argued that there were provisions of the ACA that could not survive without the individual mandate after it had been removed in the tax bill, and therefore, the entire law was unconstitutional.
Coalitions of attorneys general have already notified the Fifth Circuit Court of Appeals that they would appeal the decision, and many predict that the legal battle will be taken to the Supreme Court. Many are baffled by O’Connor’s decision so close to the new year, as open enrollment for the online exchanges were coming to a close. Suddenly dismissing the ACA would dramatically disrupt healthcare markets — a fact even expressly acknowledged by the Trump administration. Therefore, it has been agreed by all parties involved that Obamacare will stay in effect during the appeal process.
The real question is, once this ruling is appealed to the Supreme Court, whether O’Connor’s ruling will be affirmed or overruled. From previous cases, the Supreme Court has proven hesitant to strike down federal laws. Chief Justice John Roberts even mentioned in his opinion in King v. Burwell that the court should “err on the side of sustaining federal laws.” Additionally, there is a long-standing legal doctrine known as “severability” that must be considered, where if one provision of a statute removed, the rest of the law should be left in place unless Congress explicitly stated the law could not continue to exist without the provision in question.
Because of these considerations, Democrats may continue to have hope that Obamacare will once again be vindicated by the Supreme Court. Yet, with the increasingly conservative nature of the nation’s highest court, nothing is out of the question. If O’Connor’s ruling is upheld by higher courts, Republicans could use the period during the appeal process when the ACA is still in effect to pass a replacement bill that could aim to fill the gap that would be created from its dissolution. However, they could not manage this when they controlled both the House and the Senate. Based on the record-breaking government shutdown this past January, it also seems unlikely that any bipartisan healthcare plan will be authored without dramatic developments in Congress.
Obamacare has undoubtedly been influential in the past decade. Since its inception, between 30 and 50 million more Americans have gained access to healthcare. CBO has determined that the budget deficit had been reduced by $143 million between 2010-2019 because of its programs. No one has to agree with all aspects of the law, but many citizens have come to rely on the ACA for coverage. My aunt is one of those people, counting on plans accessible through Obamacare to subsidize her $500-a-pill medicine that prevents the tumors in her lungs from growing beyond their current size.
Impacting countless elements and facets of the healthcare industry, the bill would leave a significant void if repealed. Perhaps this had been an intention of the Democrats who authored Obamacare, which spanned over 2,000 pages at the time of its passage. Maybe they had predicted that if they were able to overhaul the healthcare system which a bill of such magnitude, it would become too integral to the system to simply be repealed. Some alternative bill must be offered to take the place of the ACA if people truly wish to do away with its effects. If Republicans in Congress or conservative judges wish to finally kill the ACA, a feat that has proven elusive for the past ten years, it is vital that they come up with a practical alternative that doesn’t leave millions of Americans out to dry.