Ahh, summer. Baseball. Watermelon. Court decisions on Obamacare. Summer seems to be the season for head scratching court decisions about one of the most politically divisive laws in the last decade, if not the 21st century. It was only two summers ago that the Supreme Court opinion in NFIB v. Sebelius resulted in more than 20 states forgoing to expand Medicaid, leaving approximately 5.7 million lower-income Americans uninsured. In my home state of Virginia, that means my fellow Virginian making about $16,000 a year, or less than $8 an hour does not have the choice to sign up for health insurance because really, who needs health insurance when you need to eat?
There are infinitely more qualified legal minds that can discuss the legal reasoning behind both court decisions so I won’t expound on yesterday’s rulings in the D.C. Circuit and Fourth Circuit Court of Appeals. Just a note that like the luxuries of summer–watching a baseball game or eating a slice of watermelon–accessing health care should not be a luxury only for those that can afford it.
Here at CHIR we follow health insurance issues with an eye to what we call “the 3 As”: access, affordability, and adequacy. Prior to enactment of the Affordable Care Act, as has been well documented, the non-group private health insurance market failed on all three fronts: (1) Many could not access insurance at any price because of their health status or other risk factors. (2) Those who could access it often found it unaffordable without an employer or government subsidy, and many faced premium surcharges because of their health status, gender, or age. (3) And coverage was often inadequate because it excluded coverage for pre-existing conditions, failed to cover critical benefits such as maternity care, mental health and substance use services, and prescription drugs, and often included annual or lifetime caps on benefits that left people with costly conditions out in the cold. Further, we know that a lack of health insurance can have life or death consequences. Prior to enactment of the ACA, an estimated 22,000 people per year died because they didn’t have coverage.
This much is not in doubt: the authors of the ACA intended to address all of the 3 As. And the premium subsidies play a major part to ensure that health insurance is not just available and adequate, but also affordable, particularly to lower and moderate income people who don’t get employer premium subsidies through their jobs. If the D.C. Circuit’s ruling stands, it not only sets an unfortunate example of an activist court ignoring congressional intent, it has potentially tragic consequence for an estimated 7.3 million Americans who likely won’t access the care they need because health insurance is simply unaffordable.