What’s at Stake as Affordable Care Act Goes Under the Knife of the Conservative Supreme Court

Her foot was amputated as a result of uncontrolled diabetes. She couldn’t afford her insulin. People make choices based on the options that they have. Without health insurance, she didn’t have many options. After the passage of the Affordable Care Act (ACA), this patient was eligible for insurance and her diabetes wasn’t held against her. She had the resources to manage her illness and even received a prosthetic foot. Her choices for better health was directly related to the ACA.

The ACA was passed with three main objectives: to increase health insurance coverage, reduce rising healthcare costs and improve the quality of care provided. It did all of the above for this patient.

The United States Constitution does not set forth an explicit right to healthcare but the COVID-19 pandemic has exposed how poor health is a threat to every American life. If the ACA is deemed unconstitutional by the Supreme Court, millions will lose their health insurance overnight. Congress would have to quickly act for a replacement, but deliberative legislative bodies take time to pass legislation; meanwhile, leaving Americans’ health in the crosshairs.

The Supreme Court will begin deliberations on Texas v. California on November 10th. With the new Supreme Court majority, pending the confirmation of Amy Coney Barret, the future of the ACA is in question. The makeup of the House, Senate, and Executive branch will determine what will be included in an ACA revamp should the Court rule the ACA unconstitutional. 

What the ACA has done is provide access to insurance for uninsured Americans with pre-existing conditions. It extends coverage for young adults up to the age of 26 and expands coverage for early retirees. It rebuilds the primary care workforce as well as holds insurance companies accountable for unreasonable rate increases. So why is there still an outcry of support pushing the Court to strike down the ACA?

The individual mandate is one reason. People who did not have health insurance had to obtain it or pay a penalty. Some healthy people don’t want to be required to pay. But compare this to auto-insurance. To mitigate the risk of an accident while driving, the governments in 49 states require all drivers to have auto-insurance. This is done to protect drivers from paying for accidents. Likewise, having healthy people pay for insurance is a protective investment on their health. A young healthy person can still get sick. Too often people wait until an illness hits to see a physician. 

Republicans have said they do not wish to rollback protections on preexisting conditions but a number of other popular measures of the ACA would be in jeopardy like children insured with their parent’s insurance through age 26 and Medicaid expansion. 

This is especially dangerous today since many young Americans graduating from universities are unemployed due to the virus economy. Those currently under their parents’ insurance would be left to fend for themselves. 

Some states have expanded their Medicaid programs to cover all people with household incomes below the federal poverty level. Research indicates Medicaid expansion has led to increases in access and utilization to healthcare services, improvements in financial security and positive net effects for state budgets and revenues.  In addition, expansion is associated with decreased mortality. This includes reductions in rates of food insecurity, poverty, and home evictions; and improvements in measures of self-reported healthy behaviors. Healthcare providers know that low-income and poor health go hand in hand. Keeping vulnerable populations healthy is not only cost-effective but significantly contributes to building health equity thus improving the overall fitness of our nation. 

Conservatives strongly object to the ACA due to the involvement of the federal government in the nation’s healthcare. Meanwhile liberals say the ACA gives too much power to private insurance companies. It doesn’t help that healthcare is complicated and difficult to comprehend much like the ACA itself. Problematically, people are picking political sides or aligning with rhetoric rather than trying to understand what the law actually entails.

Life is difficult without good health. Ask any patient who has been hospitalized, suffers with cancer or survived COVID-19. Patients are struggling to manage their illness and the elimination of the ACA without an alternative plan in place would put Americans in a predicament to choose between health and livelihood. Afterall, three in five bankruptcies are due to healthcare costs. 

Physicians are trained to be patient advocates. Repealing the ACA is far less popular among physicians on the frontlines of medicine than it is to polarized Americans. Doctors see the struggles of patients deciding between a needed surgery or paying their rent. Nobody likes high deductibles nor wants to be sick without health insurance. The ACA is not perfect, but we can build upon it.  

COVID-19 has opened our eyes to how stressful life can be when the health of our citizens is at risk. This year’s elections hold the fate of our nation’s well-being like none other. The stakes are too high and the consequences are many. With health becoming politicized, it’s become harder to keep politics out of the exam room. But, physicians are charged to “do no harm,” which means providing care to our patients regardless of political beliefs. Physicians know healthcare best because we are in the trenches of it everyday. The majority would agree that protecting healthcare for all patients is in alliance with the hippocratic oath. 

As the future of the ACA is in a quandary, we need to come together and vote to maintain protections offered by the ACA and advocate for healthcare to continue to be a constitutional right for all Americans. Otherwise, especially in the midst of a pandemic, our nation’s health will suffer. 

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Dr. Asha Shajahan is a primary care physician, writer and podcaster from Detroit, Michigan.