ACP Continues Advocacy for ACA as Supreme Court Decision Approaches

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Oral arguments in California v. Texas, case challenging the Affordable Care Act, scheduled to begin Nov. 10

Nov. 6, 2020 (ACP) – With the well-being of the U.S. medical system on the line, the American College of Physicians will be watching closely this month as the Supreme Court considers a landmark case challenging the constitutionality of the Affordable Care Act.

In unity with other medical societies, ACP has already made its opinion known to the justices. “Through our public statements and briefs to the courts, we have never wavered in our support for patients and physicians: The ACA must remain the law of the land,” said Bob Doherty, ACP senior vice president for governmental affairs and public policy. “It's not hyperbole to say that the entire health care system hangs in the balance.”

The Supreme Court will hear oral arguments in California v. Texas on Nov. 10. The state of Texas and 19 other states challenged the ACA in 2018, charging that the individual mandate is no longer constitutional because no penalty is assessed if people fail to get coverage. Seventeen states, led by California, are defending the ACA; the Trump administration declined to do so and instead supports overturning it.

The worst-case scenario will occur if the court overturns the entire ACA. Millions of Americans would lose insurance coverage, and there would be no more national protections against higher insurance rates and required benefits for people with preexisting conditions.

As the Kaiser Family Foundation notes, “the ACA also made other sweeping changes throughout the health care system including expanding Medicaid eligibility for low-income adults; requiring private insurance, Medicare, and Medicaid expansion coverage of preventive services with no patient cost sharing; phasing out the Medicare prescription drug doughnut hole coverage gap; reducing the growth of Medicare payments to health care providers and insurers; establishing new national initiatives to promote public health, care quality, and delivery system reforms; and authorizing a variety of tax increases to finance these changes. All of these provisions could be overturned if all or most of the ACA is struck down by the courts, and it would be enormously complex to disentangle these provisions from the overall health care system.”

In an October 2020 report, the Urban Institute estimated that 21 million people would become uninsured by 2022 if the ACA is overturned, and “the uninsured population will increase by at least 90 percent in 25 states and the District of Columbia.” Also, the institute predicted that “nationally, health care spending by and for nonelderly Americans will fall by $135 billion. This spending decline will be spread across hospitals ($56 billion), pharmaceutical manufacturers ($30 billion), physicians ($17 billion), and other services ($33 billion).”

In its friend-of-the-court brief, ACP argues that the ACA can stand – and remain constitutional – even without the individual mandate. Also, as Doherty said, the brief makes it clear that “to pull the rug out on millions of Americans during a pandemic would do incalculable harm to the health care system.”

ACP filed the brief with nearly two dozen other medical societies, including the American Medical Association, American Academy of Family Physicians, American Academy of Pediatrics and American Psychiatric Association. The brief has been refiled during each step of the judicial process, and it has been updated to reflect the devastation wrought by the coronavirus pandemic. “Health care in the United States,” the brief says, “is at a precipice.”

The brief also notes that the medical profession operates under the rule of “first, do no harm.” The final sentence of the brief states that its signatories, which include ACP, “respectfully submit that this Court should do the same.”

Doherty noted that it's impossible to know how the court will rule. Justice Amy Coney Barrett, who joined the court shortly before the election, has questioned a previous ruling that allowed the ACA to stay in place. “This certainly changes the dynamics on the court,” Doherty said. “We simply don't know what will happen.”

It's also unclear when the court may rule. “A lot is at stake,” Doherty said. “We're proud to have played a crucial role as advocates and educators.”

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