Published December 8th, 2020 at 6:00 AM
The day after her first chemotherapy treatment in 2017, Laura Packard watched Congress vote to repeal the Affordable Care Act (ACA).
Packard, diagnosed with stage four Hodgkin’s lymphoma, was a small business owner with a health policy purchased through Colorado’s marketplace.
“It was terrifying,” she said. “I was on the couch trying to figure out what on my body was breaking… and they were in the Rose Garden, yucking it up, so glad to be taking away health care from millions of Americans like me.”
Prior to the passage of the ACA, Packard had individual health plans she calls “junk” insurance that wouldn’t have paid for the hundreds of thousands of dollars it took to save her life. The ACA policy enabled her to undergo two hospital visits, six months of chemotherapy, a month of radiation and treatment complications. Her cancer is now in remission.
“The Affordable Care Act saved my life because there is no way I could have afforded treatment without it,” Packard said.
Packard is one of more than 25 million people who were able to receive insurance of some kind after the passage of the ACA.
Now, at its 10-year anniversary, a perfect storm has hit. The COVID-19 pandemic has left the nation’s health care system in crisis just as millions have lost jobs and health insurance due to the resulting economic crisis. In addition, the Supreme Court in November arguments in a case seeking to overturn the requirement for insurance coverage – a repeal some say could dismantle the law.
For those without insurance, the deadline to enroll in a 2021 marketplace plan on www.healthcare.gov is Dec. 15.
“It’s a perfect storm that’s happening right now,” said April Holman, executive director of Alliance for a Healthy Kansas. “We are in a strange time and one that isn’t good for consumers or providers or anyone who touches the system in any way.”
More than 25 million people have insurance now because of the passage of the ACA.
Overall, there are an estimated 11.4 million people enrolled in state marketplace plans. In addition, about 12 million are newly insured through Medicaid expansion. Finally, 2.6 million dependents under the age of 26 are able to remain on their parents’ plans.
A couple of well-known components of the ACA are states’ expansion of Medicaid and marketplace plans where individuals can purchase health insurance. But there are many other, more subtle, parts of the ACA that would be affected if the law were to be repealed.
“I think the ACA has touched so many American lives in the past 10 years … There are a lot of things that are normal procedure now for us that were vastly different before the ACA,” Holman said.
Some are small things, such as having calorie counts on restaurant menus and giving women a place to pump breast milk in the workplace, according to Marianne Udow-Phillips, founding executive director of the Center for Health & Research Transformation at the University of Michigan.
Another major component of the ACA included banning annual and lifetime limits on the benefits a person could receive. These limits were particularly detrimental to someone like Packard, who had major bills over a single year, or to people who spend gradually because of chronic conditions.
The passage of the ACA also brought changes to what services insurers would cover, including requiring employer and state exchange plans to cover preventive care (including health screenings and immunizations) at no cost to the patient. The law also required Medicaid expansion, small-group and individual plans to cover mental health services.
The ACA also forced insurance companies to provide coverage to people with pre-existing conditions. It prohibited insurers from hiking prices up on plans for these people as well, something commonly done on the individual market prior to the ACA.
Although the law made a dramatic change to much of the health care system, it was mostly designed to fill in gaps and cracks in insurance coverage, Udow-Phillips said. It was an incremental law that fixed market failures, but “didn’t fundamentally change the structure or finance of American health care, which is inefficient,” she said.
Health care is still overpriced, people are still uninsured and too many others are underinsured (with benefits that pay for very little of their care). Still, calling the entire law unconstitutional, she said, would be “incredibly disruptive and create chaos in the healthcare system.”
The job market has been mostly dire since employers began mass layoffs early in the pandemic.
The United States lost about 22 million jobs at the onset of the pandemic, according to the Department of Labor, and has since regained about 12 million jobs. Something heard less about is the impact those layoffs have had on peoples’ health insurance.
“In any other circumstances, this would be the top thing on the news,” said Joshua Peck, co-founder of Get America Covered. “We have seen the largest health coverage losses in history in the past year.”
It is difficult to ascertain exactly how many people have lost health insurance during the pandemic because of limited survey tools, Peck said. People have also yo-yoed between insured and uninsured as employers closed and reopened.
Some estimates have shown, however, that health insurance losses have been somewhat tempered through the pandemic. Many employers have managed to keep their workforces covered with health insurance.
According to estimates by the Henry J. Kaiser Family Foundation, there has been a 1.3% drop in employer-sponsored health insurance caused by the pandemic.
These numbers have remained relatively low because many of those who lost jobs were in industries such as retail and food service that rarely cover workers on employer health plans. Many of the other employees were at companies that used furloughs or short-term layoffs so employees could remain insured.
Considering factors like furloughs and companies that did not offer coverage, The Commonwealth Fund estimates that about 14.6 million employees and dependents lost insurance because of COVID-19 shutdowns.
Those people could use the Affordable Care Act as a health care lifeline, if they enroll in a marketplace plan on www.healthcare.gov by Dec. 15.
Holman said resources have been cut, so there is less advertising and not as many “navigators” to help people through the system. There is assistance available, though. Some federally qualified health centers and hospitals have people on staff that help consumers to get signed up for plans. Locally, organizations like CoverKC offer listings of navigators that assist people with coverage.
Peck said money is often the biggest enrollment obstacle. Depending upon family size and income, some consumers have been left without federal subsidies, making plans on the marketplace cost-prohibitive.
But according to Peck’s organization, there are 128,000 Kansans and 308,000 Missourians who are uninsured and eligible for financial help through Medicaid, marketplace subsidies or other public assistance. Generally, three-quarters of consumers should be able to find a plan for 2021 for less than $50 a month.
Udow-Phillips recommends shopping for coverage even if you already have some. Plans change each year, more insurers enter the market, and prices may go down.
But it may be uncertainty as much as cost that keeps some people from signing up for health plans this year. Watching and waiting for Congress or the Supreme Court to overturn the law has some people nervous.
“It’s like we’re living in a mashup of Groundhog’s Day and Friday the 13th,” Packard said. “Every day there’s a new killer attempt at our healthcare.”
It’s unclear how the Supreme Court will rule on the ACA challenge, or even how that ruling could impact different parts of the ACA. Either way, a decision is months down the road.
“Regardless of what the Supreme Court does, people should sign up and let next year take care of itself,” Packard said.
Tammy Worth is a freelance journalist based in Blue Springs, Missouri.