AP NEWS

Nullification of ACA without a backup plan irresponsible

April 13, 2019

The president has declared war on the Affordable Care Act. Failing to accomplish a repeal in Congress, he is now trying to have it declared unconstitutional in its entirety.

Failing on repeal in Congress, the administration had mounted a piecemeal approach to undo the act, which has increased the number of people with health insurance coverage. Now, the president is mounting a frontal assault in the courts. The U.S. Department of Justice’s recent decision not to defend the Affordable Care Act in court must be reevaluated.

Moving to completely dismantle the country’s health care system could result in the loss of health care benefits for an estimated 25 million people and place their health at risk. Going back to pre-2009 federal health policy would only increase the number of uninsured Americans who turn to high-priced, tax-supported emergency rooms to meet their health care needs.

The taxpaying American public will be the losers in this political maneuvering in the courts.

The lawsuit to overturn the ACA was filed in February 2018 by a coalition of 20 Republican state attorneys general, including Texas Attorney General Ken Paxton. The lawsuit alleges that repeal of a mandate that people have health insurance or pay a fine makes the entire law unconstitutional. That requirement was eliminated as part of a tax law signed by President Donald Trump in late 2017.

In December, U.S. District Judge Justice Reed O’Connor of the Northern District of Texas declared the entire ACA invalid, and the case proceeded to the 5th Circuit of Appeals.

In a highly unusual move late last month, the Justice Department filed a brief in support of nullification of the law, urging the 5th Circuit to affirm O’Connor’s decision.

The Affordable Care Act is not perfect, but it needs fine-tuning, not nullification. The Trump administration’s action in the case caught many off guard and has even prompted the secretary of health and human services and attorney general to ask Trump to reconsider his position on this one. This reckless course of action threatens to undermine the Trump administration’s own efforts to contain the opioid epidemic, reduce prescription drug costs and eliminate HIV in the U.S.

A rollback of services, especially in Medicaid, could have a devastating impact on people living with HIV, 40 percent of whom are covered by Medicaid, according to the Kaiser Family Foundation. Medicaid also covers about 1.2 million people receiving mental health and addiction treatment.

With no ACA in place, drugmakers will no longer be required to provide senior citizens discounts in the coverage gap of Medicare Part D and states would no longer be entitled to the discounts to Medicaid programs. The lack of mandate requiring all health plans to provide prescription drug coverage would result in many people having to pay the entire costs of prescriptions out of pocket.

It will also leave people with preexisting medical conditions with few options. Under ACA rules, a person’s medical history or health status cannot be used to deny insurance coverage or factor into the cost of insurance. More than half of nonelderly Americans and 84 percent of those ages 55 to 64 have at least one preexisting condition. They include high blood pressure, behavioral health disorder, high cholesterol, asthma/chronic lung disease, heart conditions, diabetes or cancer.

Lawmakers on both side of the aisle agree there is little chance a replacement health care plan can be approved before the 2020 elections, though administration officials recently said such a plan was in the offing. After first promising a replacement, the president backtracked, saying no such replacement will be written until after the election, only to be contradicted by others in his administration last weekend.

But even if a plan comes out of the administration, it’s not likely to increase the Republican Senate’s appetite for tackling such legislation in an election year. The party’s moves on health care are widely credited for Democratic gains in the 2018 midterm elections.

So, what we’re left with is the president, to fulfill a political campaign promise to undo one of the previous administration’s major domestic policies, having little regard for the long-term effects.

It’s not good public policy. And taking away the essential benefits of the ACA while a replacement is debated is disastrous health care policy.