Why Justice Ginsburg's death leaves the Affordable Care Act in greater danger
I wrote my first book about retirement during the Great Recession of 2008 - 2010, when millions of older Americans found themselves out of work and without health insurance. When I drafted a section on how older people needing health insurance but were too young to enroll in Medicare, about the best answer I could find was this: “good luck.”
This was before the Affordable Care Act became law in 2010. Quality health insurance was impossible to find, and people with preexisting conditions couldn’t buy insurance at all.
The ACA was passed just as my book - The Hard Times Guide to Retirement Security - was headed to the presses, and we were able to make last-minute changes to reflect the new law’s protections.
The ACA reaches into nearly every nook and cranny of the health care system. And it has been especially beneficial for older, pre-Medicare Americans - especially the guarantee of coverage for people with preexisting conditions, premium subsidies and access to Medicaid in many states. Coverage for this age group have since improved dramatically - in 2018, 8.8% of adults ages 50 to 64 were uninsured, down from 14% in 2010, according to the Commonwealth Fund. The decline would have been much greater if 14 states had not rejected the law’s Medicaid expansion, according to Commonwealth — in states that expanded, the rate for this age group has fallen to 6.4 percent.
Republicans have been trying to topple the ACA since its passage in 2010, and the latest salvo is a lawsuit, brought by 20 Republican-leaning states, and supported by the Trump administration that is now before the U.S. Supreme Court. The case centers around the Constitutionality of the ACA’s individual mandate.
The Supreme Court may hear oral arguments on this case as early as this fall, just as voters are casting ballots; a decision isn’t likely until sometime next year. If the court rules for the plaintiffs, the ACA will be gone.
The death of Justice Ruth Bader Ginsburg this month has increased attention focused on the case, with some observers predicting that a further shift of the court to the right boosts the odds that the ACA could be overturned. Legal experts say that is by no means assured- the court could uphold the law or send the case back to the lower courts.
But in the meantime, the coverage question for the pre-65 crowds is becoming even more critical as the pandemic accelerates a wave of early retirement. A new Avalere Health study finds that 12 million workers are likely to lose employer-based insurance during the pandemic, with a percentage loss of coverage among people of color that is double that for white people.
For an extensive analysis of the various ways that the ACA has reshaped the nation’s health care system, see this new brief from the Kaiser Family Foundation.
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