The Supreme Court’s strong backing of the Affordable Care Act last week has been hailed by supporters of the law as putting to rest the continuous attacks by GOP lawmakers and others opposed to it.
We’ve no illusion that Republicans will stop trying to undo it, but hopefully, given more breathing room once again, President Biden and Congress will work to strengthen the law’s failings and undo the damage done to it during the Trump administration.
The past 16 months have only served to reinforce the need for accessible care for all Americans — and accessible means being affordable. That was the purpose of the act, passed more than a decade ago. But statistics strongly suggest those in poorer areas, and minorities, have suffered more deaths and infections during the pandemic.
One of the most obvious disparities — brought into focus when President Trump and other high-level administration officials contracted COVID-19 — was the availability of top-end, expensive care for those with the resources to pay for it.
And that’s what the Affordable Care Act was designed to address. No one is naïve enough to believe the uber-wealthy won’t always have access to better care. But we can at least strive to ensure most of the other 99 percent has equal access.
Even its defenders have acknowledged through the years that the legislation wasn’t perfect. Despite being portrayed as forced down the country’s throat by overzealous liberals, the ACA was full of deep compromises necessary to gain the support of industry heavyweights, most notably insurers.
Court challenges also hindered its rollout, leaving it up to individual states whether to accept expanded Medicaid offerings. Many GOP-led states refused, including New Hampshire at first. Some other issues have since been resolved. The failure of Congress during the Trump administration to “repeal and replace” the law underscores that GOP lawmakers have never had a workable plan with which to “replace” it.
But its existence matters. President Biden reopened enrollment in the ACA marketplace for this year in February — it closes Aug. 15 — citing the pandemic, and between then and May 31, 5,425 Granite Staters signed up. Overall, nearly 70,000 in the state get their health care insurance through the marketplace.
Still to improve: the “Affordable” in Affordable Care Act is not entirely as advertised for many. Lots of options provided by private insurers on ACA exchanges realistically limit coverage through high deductibles or co-pays, or come with higher premiums than many can afford.
One of the most contentious aspects of the law from the start was the mandate under which younger, relatively healthy adults were required to participate, in order to widen the risk pool and keep costs down. But Congress subsequently eliminated the penalty for not participating, effectively wiping out the mandate. That was actually the point of the case — California v. Texas — the Supreme Court ruled on last week. The 7-2 ruling found the law can continue even without the mandate’s penalties.
Many young adults don’t want to participate, thinking their health care costs won’t amount to what the premiums would cost. The trick is to lure them into the program with lower rates, but without thereby allowing insurers to further penalize older, sicker participants, who pay higher rates under the law’s age-band rules, but who also receive greater subsidies for those rates.
Again, we fully expect attacks on the law to continue at every opportunity. There are yet more court cases in the works that aim to end or eviscerate it. But maybe last week’s ruling will provide an opportunity for Congress and the Biden administration to continue to improve an act that ought not to be a partisan rallying point.
Everyone deserves reasonable access to health care.