Opinion: The Next Act for Health Care

To start, let’s make one thing perfectly clear: the Patient Protection and Affordable Care Act (ACA) is still the law despite Republican efforts to dismantle it.

That said, last week we saw another attempt to overturn it when the U.S. Supreme Court said that, in its next term, it would hear arguments on Texas v. United States (now California v. United States). This means that it could be
heard even as Americans go to the polls to elect our next president.

At that time, thousands of Marylanders will be going to Maryland Health Connection during Open Enrollment (Nov. 1-Dec. 15, 2020) to re-enroll, or enroll for the first time, in health insurance. The uncertainty surrounding the future of the law, if not the country, will almost certainly cast a pall on the remarkable strides that have been made to provide the security of health care coverage to all Americans.

As we approach the ACA’s 10th anniversary on March 23, what does this mean for Marylanders?

Some 345,000 individuals could lose coverage — almost doubling our current uninsured rate. And those “patient protections” in the law would be obliterated including those for the 2.6 million Marylanders with pre-existing conditions.

They could face higher premiums, the loss of critical
benefits, or potentially be denied coverage altogether. In Maryland’s 1st congressional district, for example, represented by U.S. Rep. Andy Harris (R), that would include 52% of the non-elderly population. Of those, 37,300 are children ages 0-17.

The overturning of the ACA would endanger both the health of individuals and their financial security. The state’s finances would also take a hit with the potential loss of $2.9 billion in funding for Medicaid and the Children’s Health Insurance Program.

How did we get here? No surprise — it’s complicated, as explained by Katie Keith in Health Affairs.

But the key takeaway is that the U.S. Supreme Court will hear an appeal to the federal district court’s decision that the ACA should be struck down in its entirety and we won’t expect a ruling until 2021.

Maryland’s initial embrace of the promise of the ACA, and the steps it has taken over the last decade to implement, improve and defend it, are impressive. Now, in the face of multiple efforts to weaken and ultimately kill the law, we must renew our defense. The Maryland General Assembly is currently considering:

 A recommendation to cut the budget of the Maryland Health Benefit Exchange by almost 11%. Such a reduction could negatively impact the impressive innovative approach it has taken to providing an essential public service. In addition, it would appear foolhardy to hinder in any way an effective outreach and enrollment program during a period when the public will be focused on a presidential election and the airing of the ACA in the U.S. Supreme Court;

 SB872/HB959 — Health Insurance — Consumer Protections: This would codify in Maryland statute the protections afforded under the ACA;
 SB124/HB196 — Maryland Health Benefit Exchange — Establishment of a State-Based Health Insurance Subsidies Program: The Exchange has been focused on ensuring that health insurance is truly affordable and this legislation provides the opportunity to address that
issue; and
 HB1329 — Maryland Health Benefit Exchange — Establishment of a Small Business Health Insurance Subsidies Program: This would create the opportunity to ensure that employees of small businesses had access to health care coverage.

No matter what happens at the federal level, the General Assembly should do the right thing to make sure that Marylanders benefit from both the protections and the promise of the ACA.

— LENI PRESTON

The writer is an independent health policy expert.

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