Supreme Court weighs sweeping health care changes
ATLANTA — Like millions of Georgians, the Rev. Jill Henning has health insurance through her job and doesn’t shop the Affordable Care Act’s marketplace. But her job’s plan gave her the cancer screening that saved her life for free because the ACA required it.
The ACA, also known as Obamacare, is best known for the health insurance exchange marketplace where individuals can buy subsidized plans. And when it comes before the U.S. Supreme Court Nov. 10, that will be on the table. So will countless other changes that altered far corners of the U.S. health care system.
For the 160 million Americans with group insurance like Henning, the law required that insurance fully pay for doctor-ordered preventive cancer screens. It changed safety rules for nursing homes. It broadened prescription coverage for Medicare, the government insurance for the elderly, and it changed membership for Medicaid, the government insurance for the poor. It levied new taxes. It prohibited gender discrimination in a variety of health care programs.
That’s just a sampling of the law’s 900-plus pages of changes. A lawsuit brought by Texas, Georgia Attorney General Chris Carr and other Republican-led states and supported by the Trump administration seeks to unravel every piece of it.
That “would be a very, very massive undertaking,” said Alina Salganicoff, senior vice president of the Kaiser Family Foundation research center and its director of women’s health policy.
“I mean, the Affordable Care Act has now been in place for 10 years,” she said: It would change things for many who are uninsured, and many on government insurance programs.
And “it would affect nearly every individual who has private insurance coverage.”
The ACA attracted big groups as supporters or opponents. It attracted opponents from free-market groups who feared that healthier people with lower risk would be forced to buy meaty insurance they didn’t want. They were right.
It also attracted support from several patient groups. One was women’s groups, who decried insurance companies’ practice of charging women more for insurance on the basis of their gender. There were also reports of insurers’ treating domestic violence as a pre-existing condition, because victims were more likely to wind up in the emergency room.
Another group that supports the ACA is the AARP, which advocates for older Americans. AARP cites gains in the ACA that helped older people afford prescription drugs, since older people are strong consumers of them.
The process for the Food and Drug Administration to encourage and approve more affordable competitors to brand-name “biologic” drugs is encoded in the ACA. Repealing the entire law would erase that. Biologics are expensive, an AARP official said, and they need competition.
“We are just starting to see more robust biosimilar competition now, 10 years after the ACA,” said Leigh Purvis, director of health care costs and access at the AARP’s Public Policy Institute. “What happens to those products that got on the market?”
In addition, Medicare’s Part D plans used to have a “donut hole” where people would suddenly find their drug coverage had stopped. For a time, they would have to pay for all drugs out-of-pocket. After several thousand dollars’ worth of spending, the plan would pick up costs again.