The Trump administration was expected to file briefs with the U.S. Supreme Court today asking justices to strike down the Affordable Care Act as unconstitutional. In anticipation of this event, analysts at two major policy think tanks in Washington, D.C., released reports this week that detail the likely nationwide impact on health coverage if the Court were to take such an action. In addition, Democratic members of the U.S. House sought to shine new light a health care reform bill that some have described as the “ACA 2.0.”
In “The Health Care Repeal Lawsuit Could Strip Coverage from 23 Million Americans,”  analysts Nicole Rapfogel and Emily Gee of the Center for American Progress explain that the impact of such a decision, which has long been forecast to end insurance coverage for millions of Americans, will be greatly worsened as a result of the COVID-19 health pandemic. As the report notes:
Because the economic crisis stemming from the pandemic is driving millions of people onto coverage programs supported by the ACA, CAP estimates that approximately 3 million more people stand to lose coverage from the health care repeal lawsuit than the 20 million previously estimated . According to a March 2019 analysis by the Urban Institute , full repeal of the ACA would cause enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) to fall by 22.4 percent and enrollment in individual market coverage, including for the ACA marketplaces and other insurance people purchase on their own, to drop by 35.4 percent.”
The report goes on to estimate that approximately 607,000 North Carolinians (or around 6% of the state’s total population) would lose coverage, with 104,000 of the at number attributable to the pandemic. It concludes this way:
The Trump administration and its allied state leaders are attempting to undermine health care in the midst of one of the worst public health disasters in U.S. history. The ACA is crucial to helping families regain coverage and maintain some financial security against health care costs. A Supreme Court ruling against the ACA would take away health coverage from millions of Americans whose lives are already being disrupted by the economic distress and concerns about their health and well-being.”
Meanwhile, in “ACA Repeal Even More Dangerous During Pandemic and Economic Crisis,”  analysts Tara Straw and Aviva Aron-Dine of the Center on Budget and Policy Priorities, expand further on the potentially dire impact that the demise of the law:
The Supreme Court will likely decide the case in the spring of 2021, when the unemployment rate is expected to still be about10 percent and possibly amid a continuing COVID-19 public health crisis. ACA repeal was expected to cause 20 million people to lose coverage before the crisis, but millions more would likely lose coverage if the law were struck down during a deep recession, with commensurately larger impacts on access to care, financial security, health outcomes, and racial disparities in coverage and access to care. Striking down the ACA would also impede efforts to end the COVID-19 public health crisis and deal with the fallout.”
The authors also explain that the demise of the law would be felt most acutely in communities of color:
Striking down the ACA would also worsen health disparities. Prior to the ACA, uninsured rates for Black and Hispanic people were much higher than for white people, reflecting economic gaps and barriers to accessing coverage that are a legacy of systemic racism, barriers in access to coverage for people in immigrant families, and other economic and health system inequities. Black and Hispanic people were also more likely to avoid using health care due to cost. While the ACA did not eliminate these gaps, it narrowed disparities in both coverage and access to care significantly, and striking down the law would widen them once again.”
North Carolina, as represented by Attorney General Josh Stein, is one of several states, including California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia that have weighed in with the Supreme Court in support of keeping the law.
Another group of states, including Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah, and West Virginia, are backing the Trump administration.
Democratic reform legislation
In an effort to counter the threat to the ACA and communicate an alternative vision, U.S. House Democrats are reviving their push to expand and enhance the law with legislation dubbed the “Patient Protection and Affordable Care Enhancement Act.”  The proposal would, among many other things:
- Lower the cost of coverage for ACA plans via an expansion of family tax credits and other tools,
- Push hold-out states like North Carolina to finally opt for Medicaid expansion,
- Invest in expanded consumer outreach, education and enrollment,
- Lower barriers to coverage and care, with a particular focus on addressing challenges confronting communities of color,
- Crack down on junk plans and strengthen protections for people with pre-existing conditions, and
- Negotiate lower prescription drug prices.
The bill received a hearing  in the House Rules Committee yesterday.