By Simon F. Haeder
Once more, the Affordable Care Act is taking center stage.
This time, it is at the Fifth Circuit Court of Appeals in New Orleans. The stakes are high once more, with potentially the entirety of the ACA on line. No doubt, the case will likely end up in front of the Supreme Court again. But then again, courts are hard to predict these days, and some truly outrageous legal theories are making it into verdicts these days.
Much is at stake, especially for Pennsylvania.
Much of the public conversation about the ACA has focused on the Medicaid expansion and the insurance marketplaces. Rightfully so. Tens of millions have been able to gain insurance coverage and access to valuable care including substance abuse treatment. Yet striking down the law would have dramatic implications for all Americans, from newborns to seniors.
Think free preventive care including vaccinations and pap smears. Think filling the donut hole for prescriptions in Medicare Part D. Think consumer protections for every American including those getting their insurance through their employer.
No annual and life-time limits. Minimum levels of benefits. Guaranteed coverage. No exclusion of pre-existing conditions. Protections for breastfeeding mothers in the workplace. Keeping your kids on your insurance plan until they are 26.
Yet, there are even subtler changes that would have significant implications. Calorie labels in restaurants. Experiments on how we pay for medical services. Biosimilar drug approvals. The Indian Health Service. The list goes on.
As U.S. Senate Majority Leader Mitch McConnell, R-Ky. often reminds us, the ACA has a lot of pages. And they are all filled with policies.
All of it hangs in the balance, in front of a three-judge panel down in New Orleans. Judging by their questions this week, they know very little about politics and health care policy. This may not bode well for all of us. It also says a lot about the quality of judges getting life-time appointments these days.
But Republicans including President Trump don’t want us to worry. Their health care plan is just around the corner. So they say. Of course, we have heard this line before. I lost count how many times. Surprise! There is no Republican alternative.
There won’t be any, either. Republicans have held the U.S. Congress for years without even coming up with a comprehensive proposal, let alone passing one. Scribbling lines on a piece of paper like “more competition,” “less government,” and “consumer-empowerment” does not make for a plan. Neither does standing in front of a PowerPoint presentation. Sorry, Paul Ryan.
And don’t get me wrong. Health policy folks like myself are longing for a true conservative alternative to reform our dysfunctional health care system. We need to. It is a disasters. Believe me, I know. I study it for a living.
Yet Republicans have basically abdicated health reform to the Democrats. In Washington, DC and almost every state capital.
From a Democratic standpoint, that’s a disaster. We have two parties, and one has virtually no proposals to fix one-fifth of our economy besides sabotaging everything the other party puts in place. A true disaster, indeed. We have wasted a decade on bickering about the ACA, and our health care system is spending billions more and we are obtaining dismal outcomes.
So for now, the situation is pretty clear. We either get what the ACA holds for us, or we revert back to the status quo ante, pre March 2010. All the good ACA stuff that the vast majority of Americans support will be gone. Puff!
I already listed what that would entail for all Americans. Yet the implications for state budgets and medical providers will be cataclysmic.
Massive budget holes. Millions of uninsured still requiring medical care. Hospital closures, especially in rural America. Lack of treatment for those suffering from the opioid epidemic ravaging Appalachia and the U.S.
We should all be worried.
Simon F. Haeder is an Assistant Professor of Public Policy at Penn State University’s School of Public Policy. He is also a Fellow in the Interdisciplinary Research Leaders Program, a national leadership development program supported by the Robert Wood Johnson Foundation. His work appears frequently on the Capital-Star’s Commentary Page