Despite the importance of the Affordable Care Act (ACA) and Medicaid expansion in providing health coverage in the midst of a pandemic, proponents of the lawsuit to dismantle the ACA, including Republican state Attorneys General and the Trump administration, march on. Oral arguments are scheduled for November 10 in front of the Supreme Court of the United States, with a decision expected in the spring of 2021. If the lawsuit is successful, 20 million Americans, including over 160,000 West Virginians, will lose their health coverage altogether and hundreds of thousands more will be impacted by other provisions of the Affordable Care Act falling.
The lawsuit, filed in February of 2018 by 18 Republican Attorneys General including West Virginia’s Patrick Morrisey, hinges on a change to the ACA’s individual mandate or requirement that all Americans must have health coverage or face a tax penalty. Under the 2017 Tax Cuts and Jobs Act (TCJA), Congress zeroed-out the tax penalty associated with the individual mandate. The legal argument by those in favor of repeal is that Congress’ actions under the TCJA should render the ACA invalid.
Last week, the Republican Attorneys General filed a brief to the Supreme Court highlighting their arguments and case. In this brief, they argue that the entire ACA, from pre-existing condition protections to the Medicaid expansion, should be dismantled stating, “the mandate is unconstitutional, and…the mandate is inseverable from the ACA’s major and minor provisions.”
While legal scholars and experts on both sides of the aisle have spoken out about the absurdity of this legal argument, the case has made its way to the highest court in the land where the future of the nation’s health care system will be decided.
No state has benefited more than West Virginia from the ACA, thus no state has more to lose if the ACA is overturned. West Virginia saw the nation’s highest drop in the uninsured rate upon passage of the ACA, going from 14 percent of the population uninsured in 2013 to only 6 percent in 2016.
If the entire ACA is overturned, as the Republican Attorneys General and the White House are arguing for, the resulting impacts for our state’s economy and our people will be widespread and devastating. In addition to 162,000 West Virginians losing their health coverage, pre-existing condition protections will no longer be required to be covered. West Virginia has the highest rate in the country of non-elderly adults with declinable pre-existing conditions under pre-ACA practices.
Additional provisions of the ACA that would end if the lawsuit is successful include:
Research shows that the ACA has improved access to care, financial security, and health outcomes while significantly narrowing racial disparities in health coverage. Strong evidence has shown that both Medicaid expansion and coverage through the ACA marketplaces save lives – more than 435 in West Virginia alone since 2014. Reversing coverage gains would worsen all of these outcomes, with effects being even more severe due to the pandemic and recession.
