By Carol Paris, M.D.
The Tennessean (Nashville), September 27, 2018
On Sept. 5, Tennessee Attorney General Herbert Slatery, along with 19 other state AGs, filed a lawsuit against the U.S. Department of Health and Human Services.
If successful, this suit will render the Affordable Care Act unconstitutional, which would have dramatic effects on the health of millions of Tennesseans, whether they support the ACA or not.
Many people think of the ACA, sometimes called āObamacare,ā simply as a marketplace for health insurance, often with subsidies from the federal government. But the ACA is much more than a marketplace.
Since the ACA was signed into law in 2010, 255,800 Tennesseans have secured coverage. The ACAās patient protection rules mean that 2.7 million Tennesseans with pre-existing conditions now have insurance.
The ACA also prohibits insurers from charging women more than men, and limits how much insurers can charge older adults. Parents can keep children on their health plans until the age of 26, instead of 19, when many young people are in school or working part time.
One of the most important elements of the ACA is the option for states to expand Medicaid. If our state legislature had passed Medicaid expansion, 163,000 more Tennesseans would have coverage today.
Despite these breakthroughs, the ACA has been tremendously controversial. Opponents argue the law increased premiums for those who earn too much to qualify for federal subsidies, and that the ACAās āindividual mandateā slapped an unfair tax penalty on those who purchased skimpy, non-compliant plans or skipped coverage altogether.
This individual mandate in particular is the target of the state lawsuits. When the mandate was challenged in 2012, the U.S. Supreme Court ruled that it was a tax; since Congress has the right to implement taxes, the court did not strike it down. However, since Congress āzeroed outā the mandateās tax penalty in 2017, Tennessee and other states argue that the entire ACA is now unconstitutional.
I am a physician — not a lawyer — so I canāt speak to the legal merits of the case. But as a doctor, I can tell you that as bad as our health system is now, it was much worse before 2010.
Former health insurance executive Wendell Potter said it best: āThings were great pre-ACA, unless you had the audacity to be born sick, a woman, get sick, enter adulthood, live beyond 50 or live in poverty. If you did any of those things, it got pretty rocky.ā
Republican attempts to ārepeal and replaceā the ACA in 2017 (without, as it turns out, a replacement plan) revealed how much Americans value the law and, frankly, how desperate we are for any kind of protections in the insurance marketplace.
Even Sen. Lamar Alexander knows how popular the ACA is: Heās co-sponsoring the āEnsuring Coverage for Patients with Pre-Existing Conditions Act.ā Sounds good, until you read the fine print. The bill allows insurers to write policies with coverage loopholes for pre-existing conditions.
For example, if you have Type 1 diabetes, a company like Aetna canāt refuse to sell you a policy, but they can refuse to cover your diabetes in that policy! Which makes as much sense as selling a homeownersā policy that doesnāt cover the roof. Or the walls.
For all ACAās benefits — it halved the number of uninsured and curbed the insurance industryās most ruthless practices — the law was just a bandage on a broken health system.
The ACAās core flaw is its reliance on private insurance to reduce costs and expand coverage. The profit-driven insurance industry is the rotten apple poisoning everything else in the health care barrel, increasing administrative bloat and diverting dollars from needed medical care. Each year, insurers continue to strip down policies, increase out-of-pocket costs, maintain restrictive networks, and deny care. And at the same time, boast record profits.
As a doctor, I am trained to treat a patientās immediate condition, but also address their long-term health prospects. Today, we must stop the bleeding and keep the ACA intact. But we quickly need to move on to the only system that is proven to both reduce costs and expand coverage — a single-payer, improved Medicare for All.
Carol Paris, M.D, is a retired physician and president of Physicians for a National Health Program.