As ACA Turns 10, Pandemic Response Depends on It — But Trump’s Lawsuit Threatens to Eliminate It

The importance of the ACA’s contribution to public health is clear. If it were overturned, as Trump wants, then tens of millions of people could pay more for the health coverage they already have or they could once again be denied coverage altogether over pre-existing conditions.

Trump Wants Supreme Court to Strike Down the ACA

As COVID-19 diagnoses increase, the Trump-Pence administration and 18 Republican state attorneys general are doubling down on a lawsuit that would end the ACA and put millions of Americans’ health care in jeopardy. 

If the Supreme Court sides with the Trump-Pence administration, it would eliminate Medicaid expansion, protections for people with pre-existing conditions, parental coverage for children up to age 26, and the ACA’s other expansions of access. Without those expansions, the number of uninsured people would increase by 65% — with a projected 20 million people losing their health coverage.

Here are just a few of the consequences Americans would face if the Trump administration succeeds at striking down the ACA:

• 130 million Americans with pre-existing conditions would lose the protections that prohibit health insurance plans from denying them coverage;

• 17 million people would lose Medicaid coverage;

• 2 million people aged 19-25 would lose coverage under their parents’ insurance plans; 

• An estimated 105 million Americans could once again face dollar limits on how much health insurance they could use in their lifetime — so one serious illness could mean bankruptcy.

We Won’t Go Back to the State of Reproductive Health Before the ACA

The ACA significantly expanded coverage for reproductive health. Before the ACA:

• Insurance abuses like “gender rating” meant that insurers charged women higher premiums — sometimes hundreds of dollars more per year than men for the same coverage.  

• Millions of people were denied coverage for “pre-existing conditions” such as  breast cancer, pregnancy, and domestic abuse.

• Birth control accounted for 30% to 44% of women’s out-of-pocket health care costs because insurers had no obligation to cover it.

After its implementation in 2013, the ACA ended those insurance abuses. For the first time in American history, every insurance plan was required to provide basic preventive care with no out-of-pocket costs for enrollees — including all FDA-approved methods of birth control, as well as services like breast and cervical cancer screenings, annual gynecological exams, prenatal care, and breastfeeding supplies.

The health care law’s birth control mandate saved Americans an estimated $1.4 billion on birth control pills in just the first year after the law took effect. The ACA expanded access to no-copay birth control to 63 million women in total —  an extraordinary achievement.

But with Trump’s case in the Supreme Court, that progress is at risk.

Trump’s COVID-19 Response Was Weak Because Trump Hamstrung the Health Care System

Since it took office, the Trump-Pence administration has sabotaged the ACA time after time. It defunded and drastically curbed ACA enrollment assistance, allowed junk health insurance plans to be sold on the marketplaces, and shortened the enrollment period. Meanwhile, several state politicians who follow the administration’s lead have refused to expand Medicaid under the ACA — a decision that leaves millions of people eligible under the law without access to health insurance. This chipping away at meaningful coverage is compounded by a slew of attacks on other aspects of our public health care infrastructure, particularly safety-net programs like Medicaid and trusted health care providers like Planned Parenthood.

America is now paying the price for Trump’s agenda. His administration's response to the COVID-19 pandemic has been slow and inadequate. The years-long effort to gut the ACA, and muddled messaging about whether insurers will cover COVID-19 tests, may result in confusion and fewer people getting tested. 

The stakes for public health couldn't be higher.