Overturning the ACA will make COVID-19 much worse

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Coronavirus testing center located at Barcroft Community Center in the Arlington, Virginia.

Donald Trump won’t wear a mask in public or suspend his in-person rallies and pushes to re-open the economy. As infuriating as Trump’s COVID-19 response has been for its incongruence with public health recommendations, the real outrage is his persistent attempts to overturn the Affordable Care Act (ACA).

The brief Trump just filed with the U.S Supreme Court in Texas v. US case is unequivocal. The administration argues that the individual mandate is unconstitutional and therefore “the entire ACA must fall.” The Supreme Court will hear arguments as soon as this fall and render its decision well after the election. Given the pandemic, this issue deserves our full attention.

Without the ACA, the catastrophic U.S. response to COVID-19 would have been even worse. And if Trump succeeds in dismantling the ACA, the long-term health consequences for millions of Americans will be dire.

On June 10, the United States passed a grim milestone: we exceeded two million COVID-19 cases. Those lucky enough to recover may face a new hurdle along with unknown future health consequences: having a preexisting condition. Thanks to the Affordable Care Act, the more than 592,000 people who have recovered from COVID-19 do not need to worry about being denied coverage or charged more because of it.

Without protection for preexisting conditions, Americans who recover from COVID-19 will have a lot to worry about. Not only do we not yet fully understand COVID-19’s long-term health consequences, but there are also no objective measures of severity.

Insurers, already quick to label things preexisting conditions when they could avoid paying for related care, are likely to sweep all COVID-19 recoveries and people who tested positive into one exclusion group — for “fairness.” Even without COVID-19, more than 130 million Americans have preexisting conditions. That means more than half of the non-elderly population in the U.S. is at risk of being uninsured if they lose their current health coverage.

In addition to protecting people with preexisting conditions, the ACA has provided affordable health insurance coverage to millions by expanding Medicaid and establishing exchanges that sell subsidized health insurance. This coverage matters in a pandemic.

Medicaid expansion covers more than 16 million low-income Americans. Without this coverage, many fewer would have been able to access care if they got sick with COVID-19. These are people commonly working front-line jobs, such as grocery store workers, who are more at risk of exposure to the virus. Their lack of access to care puts everyone they have contact with at risk of infection.

If the ACA is repealed, Medicaid expansion is in jeopardy. A repeal will almost certainly block any possibility of the 14 states that haven’t expanded Medicaid from doing so. Insurance subsidies for purchasing private coverage on the health insurance marketplaces will also disappear. 

Together, these free and low-cost insurance options are salvation for many of the 47 million Americans who have lost their jobs and with them their health insurance. If the ACA is overturned, this newly vulnerable swath of the population will have little, if any, access to insurance. Millions will face longer coverage gaps and persistent uninsurance. Increasing insurance access shouldn’t just be a priority for uninsured individuals; in the midst of a pandemic, people without insurance will create an unbearable strain on the already stretched social safety net and health care system in America. 

Another critical pandemic protection provided by the ACA is mental health coverage, which requires mental health benefits to be included in insurance sold to small businesses and individuals. With anxiety and depression on the rise, access to mental health care has been a lifeline for many during the pandemic and will continue to be critical. Nearly half of Americans report that the coronavirus crisis is harming their mental health.

The long-term mental health burdens are difficult to calculate, but experts project significant increases in psychological distress, including clinical depression and posttraumatic stress disorder (PTSD). Trauma markers will likely emerge following the immediate crisis. Access to mental health care will be vital for a robust economic recovery, and for the healing of the nation. Without the ACA, mental health benefits — already insufficient for many — are likely to be cut from insurance plans as a way for insurers and employers to save money. 

To remedy the health and economic risks of losing the ACA, Americans should take a public health approach to vote. Just as each of us can individually help prevent the spread of COVID-19 by wearing a mask and staying socially distanced, every person’s vote can help protect the health and financial well-being of us all. As bad as COVID-19 has been for America, imagine how much worse it would be without these benefits. That’s the world the Trump administration is fighting to create.

Don’t be distracted. Come November, vote like your life depends on it. It just might.

Rosemarie Day is the founder & CEO of Day Health Strategies and author of “Marching Toward Coverage:  How Women Can Lead the Fight for Universal Healthcare.” Follow her on Twitter:  @Rosemarie_Day1

Deborah Gordon is an Aspen Institute Health Innovators fellow and author of “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money.” Follow her on Twitter: @gordondeb

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