This year, Americans ’access to health care has come into the spotlight like never before.
Since March, more than 250,000 people infected with the coronavirus have died and millions more have lost their health insurance in the economic crisis caused by the pandemic.
During the presidential campaign, both Donald Trump and elected president Joe Biden promised a lot to address these health and economic issues, sparing how Americans could best be provided with access to health care. At the heart of both of their arguments remained a decade – long law: the Affordable Care Act – a milestone health law that has shown its continuing importance in this particularly difficult year.
Trump wanted to dismantle it while consistently promising a replacement plan that would never materialize, and Biden promised to build on the current law, hoping to offer a public opportunity.
“Healthcare is a kitchen table issue for most Americans, both because of the cost and what it means to live life without coverage,” said Leslie Dach, a former senior adviser to the Department of Health and Human Services during the Obama administration. .
“We are in a year when people need the ACA more than ever, and years of research have shown how its coverage has a positive impact on people’s health, life expectancy and employability,” Dach added. , the founder of Protect Our Care, a liberal group dedicated to protecting the law. “And yet for purely partisan or ideological reasons, people are trying to dismantle it.”
These efforts have not been particularly effective.
“Great safety net during a pandemic”
Just over 10 years after the enactment of a law known as Obamacare, landmark health legislation has survived many attacks by the Trump government and appears to be deeply embedded in the nation’s health care system. It’s hard to dispute the impact it has had during this difficult year – whether in politics, in politics, or at the kitchen table.
Although it is currently difficult to know exactly how many will be left without health insurance due to the current economic crisis, between February and June some 14.6 million people – workers and dependents – were affected by job losses, which also resulted in lost workers. health insurance, concluded the Commonwealth Fund estimate.
In the states that have undergone Medicaid expansion, the Affordable Care Act has helped some of these losses, especially as the list of low-income state health insurance options tightened this year.
Other people found opportunities through plans offered by the ACA, or received coverage from a spouse or parent, COBRA, short-term health plans, or were just deprived.
The exact number of people lost in 2020 will remain unknown until the end of next year. The Congressional Budget Office released a report in September looking at the number of people not insured in 2019 – 30 million – and they estimate it could jump 1 million people because of the epidemic.
However, they concluded that the situation could have been worse if not for the opportunities offered through the ACA and the ways in which Medicaid was extended by law.
“In many states, no matter how poor you are or how much income you lost, you may still not have been eligible for Medicaid before the ACA existed,” said Cynthia Cox, vice president of the Kaiser Family Foundation and ACA program director. “So the Medicaid program was a big safety net at the time of the pandemic and its economic turmoil, and everything that happened as a result.”
The law appears to remain fairly durable, despite virtually losing the individual mandate that required all Americans to sign up for health insurance or face a costly tax fine. Using a 2017 tax bill, Trump set the penalty at $ 0 for violating an individual order.
The Supreme Court may still decide to annul some or all of the law next year, but many believe this is unlikely after the judges heard oral arguments earlier this month.
Trump appears to be leaving office without fulfilling his promise to “remove and replace” Obamacare – or even just “repeal” it.
The impossibility of the law was either extremely difficult to dismantle, according to many experts, because it was so deeply fried in the U.S. health care system. So much so that it would be difficult for consumers and insurers to imagine the health landscape once it is gone.
“Everyone talks about Obamacare as if it were something, an object like the federal government or the federal budget is pointing to Obamacare, but that’s not the case,” said Chris Pope, head of ACA and eligibility. coworker. reform at the Manhattan Institute, a conservative think tank. “The Affordable Care Act has tampered with federal laws in 1,000 different places, many of which have changed since then. There are new laws that depend on this. So you can’t just be hit down.
The law has also reached its peak popularity since its adoption in 2010, with 55 percent of Americans saying they favor the ACA, the Kaiser Family Foundation says. Experts attribute the growing unfavorability to Trump’s threat of removing it without a clear replacement plan.
There is a very good chance that people who are not currently insured can actually cover for free. But they should act quickly.
Trump tried to break the law by cutting the marketing budget for open enrollment and information by 90 percent, according to the Kaiser Family Foundation.
According to Cox, many are unaware that, as a result, they are currently eligible for health insurance through the ACA or that they can currently register for coverage until December 15th.
“Four out of ten insurers are eligible for free coverage, either a Medicaid or a zero premium bronze plan,” he said, citing a plan offered through the ACA. “So there’s a very good chance that people who aren’t insured now can actually cover them for free. But they should act quickly.
Is “Bidencare” next?
Biden said he has big plans to build on top of the law so others can access health care. However, it can be a challenge to do a lot in Congress, as both chambers face little room for maneuver in both directions in running the party.
While the former vice president said he plans to introduce a public option called “Bidencare,” few think he will be able to persuade Republicans to buy into such a plan.
He is more likely to try to undo some of the Trump administration’s efforts to undermine the ACA instead, while also looking at ways to lure dozens of states that have rejected Medicaid expansion.
The stalemate is largely due to the governments of Republican-controlled states that refused largely free federal funding for Medicaid expansion for ideological reasons around budget spending and its relationship with the Obama administration.
But Benjamin Sommers, a professor of health policy and economics at Harvard TH Chan School of Public Health, says these states are rejecting the economic benefits offered by the federal government.
States did not have to cut any programs and saw huge economic benefits when they decided to expand, a June analysis concluded in the New England Journal of Medicine concluded.
“This is a victory for the state budget and clearly for patients,” – he said. “And if we take it all together, it can be seen that Medicaid is not only a public health investment at a time of an epidemic, but also a kind of stimulus to the local and state economy.”
While 12 states continue to reject the expansion of Medicaid, which is likely to provide health insurance for 2 million people, voters in Missouri and Oklahoma, both considered conservative states, have chosen to exercise the option this year through a voting initiative, apparently proving that ACAs are generally popular.
Biden is expected to try to find a way to encourage the remaining 12 states to expand, which would largely benefit members of the working poor, but that may take some time.
According to the Pope, it is inevitable that states will eventually sign themselves. He noted that it took nearly 20 years for all states to accept Medicaid after Lyndon B. Johnson signed the law as part of his “War on Poverty”.
“From a state standpoint, it’s a pretty good deal,” Pope said. “They get $ 9 from the federal government for every dollar they spend themselves. So I guess everyone assumes he’ll end up taking it, but the question is, how much does the Democratic House, the Biden administration, and the evenly divided Senate put some extra money on the table to move the needle in that direction?