Obamacare is cushioning the fall for many Americans who have lost their health insurance, along with their jobs, in the coronavirus pandemic. Millions of the newly unemployed are eligible for premium subsidies if they buy individual policies on the marketplaces created under the Affordable Care Act. Millions more are eligible for Medicaid, which was expanded in most states under the ACA.
Thus, the law, now 10 years old, is demonstrating its ability to protect families during an economic crisis. Americans have grown fond of some of its other virtues as well — including provisions that require insurers to cover people with preexisting health problems, not limit the amount of coverage they provide over a lifetime and allow young adults to remain on their parents’ policies until they turn 26.
Add in that the law has shrunk the uninsured population by some 20 million, two-thirds of whom are now covered by Medicaid, and it’s clear that the House of Representatives was right to pass legislation last month to reinforce the system.
Unfortunately, President Donald Trump is taking the opposite tack. His administration is urging the Supreme Court to strike down the law altogether over a dubious technicality having to do with Congress’s action, in 2017, to eliminate a tax penalty for going without health insurance. If Trump were to succeed, Americans without employer health insurance would be left with few options, millions of Medicaid recipients would lose coverage and people with pre-existing conditions — now including COVID-19 — might not be able to find affordable alternatives. Nor has the administration proposed any replacement for the law; its plan is to wait and see what the court decides and then, if necessary, throw together something new — a challenge that has perpetually eluded Republicans.
Heading into an election at a time of such extraordinary insecurity, the Republican-led Senate would be wise to reconsider its intention to ignore the House bill.
The legislation would address a number of weaknesses in Obamacare that have become obvious over its first 10 years — including excessive premiums for individual insurance policies sold on its exchanges. Monthly payments have proved unaffordable for many families whose household incomes exceed the threshold for premium tax credits. The House bill would do away with that ceiling — currently set at 400% of the federal poverty line — and instead subsidize all families and individuals so that no one spends more than 8.5% of their income on premiums.
The bill would also fix the so-called family glitch, a provision that prevents families from receiving subsidies if any member can get individual insurance from his or her employer costing no more than 9.5% of household income. The new rule would measure affordability by the employee’s cost for family coverage, making some 6 million more people eligible for premium tax credits.
Experience has shown, too, that states with their own exchanges enroll more people than do those that rely on HealthCare.gov, the federal marketplace. The legislation would provide $200 million a year to create new state exchanges, plus another $100 million annually to assist the uninsured in signing up. It also offers $10 billion a year to help states either create reinsurance programs to protect insurers from the most expensive claims, or to further subsidize people who buy individual or family policies.
Crucially, the bill would reverse or prevent various bits of Trump administration mischief that stand to weaken the ACA: It would, for instance, block a rule that would allow “short-term” insurance policies (which don’t meet ACA guidelines) to last three years rather than just three months, and prevent another change that would permit states to provide tax credits for plans that don’t comply with the law’s standards.
The legislation now goes to the Senate, where Republican leaders are prepared to ignore it. They’ve been entirely consistent in their refusal to the support the ACA — and in their unwillingness to offer a good alternative. It would be smarter, during a pandemic, to finally recognize how vital a safety net Obamacare has become.
