are getting health insurance
through the Affordable Care Act
than ever before, providing new evidence of the law's worth even as its survival is dependent on a Supreme Court
decision that could come as soon as Monday.
According to a report issued Saturday by the Department of Health and Human Services
, approximately 31 million people now have coverage through “Obamacare
,” which means they have enrolled in newly expanded Medicaid
programs or purchased subsidized insurance through HealthCare.gov or state exchanges such as Covered California
This is the highest enrollment figure ever, reflecting a nearly 4 million-person increase in enrollment between 2020 and 2021, following four years of basically flat combined enrollment in the Affordable Care Act's programs.
Given how many people lost income or jobs
as a result of the pandemic
, the surge is not surprising. One of the primary goals of the Affordable Care Act is to create a safety net so that people can get insurance and pay for medical care even if they don't have access to employer-based insurance or can't afford premiums.
Furthermore, the program as a whole is under new management. During his presidency, President Donald Trump
worked with Republicans
to repeal the program; while they failed, the administration cut funding for outreach and promotion, reflecting Trump's open hostility to the program.
, who famously referred to the Affordable Care Act as a "big fucking deal
" when President Barack Obama
signed it in 2010, has taken a very different stance, establishing a new "open enrollment" period that will run through August with an extension.
A new HHS report shows record ACA enrollment, as the marketplace and Medicaid serve as a safety net during the pandemic. This is an understatement, because it excludes signups during the Biden administration
's special enrollment period.https://t.co/z8bNM6VvGP
— Larry Levitt (@larry_levitt) June 5, 2021
Not only that, but he collaborated with Democratic
leaders in Congress to pass a COVID-19
relief bill that increased the financial assistance provided by the program.
Historically, one of the law's biggest problems was that some middle-class people trying to buy coverage on their own through the exchanges faced high premiums and out-of-pocket costs; the new financial assistance has made those policies much more affordable.
The most recent enrollment figures do not include the recent months when Biden reopened enrollment and the Democratic COVID-19 relief bill made that new assistance available. “The actual total as of TODAY could be as high as 33.5 million...or 10% of the entire U.S. population,” Charles Gaba, health care
analyst from ACASignups.net, tweeted.
Everything is predicated on a forthcoming Supreme Court decision.
Both Biden and Democratic leaders want to make the new subsidies permanent, but that can only happen if the Affordable Care Act is still in effect, which is not guaranteed at the moment.
The reason for this is an impending Supreme Court decision in the case of California v. Texas
, which alleges that a fatal constitutional flaw requires the justices to strike down the entire statute.
California v. Texas is the third such case to reach the Supreme Court, and by far the weakest on the merits.
Even outspoken opponents of the law who were architects of previous constitutional challenges have said this one should fail. During oral arguments in November, several conservative justices appointed by Republican presidents joined the Democratic appointees in openly questioning the lawsuit
's central claims.
As a result, most legal experts believe the case will fail; however, there is no way to be certain, and while the law has mostly survived previous challenges, those were in the days when the presence of Ruth Bader Ginsburg on the court meant four near-certain votes
to uphold the law.
Because the Affordable Care Act's changes to financing and regulations affect virtually every aspect of the health-care system, a decision to invalidate the entire law, or even parts of it, could cause chaos. Just figuring out how to implement such a ruling would be an administrative nightmare for officials in both the public and private sectors.
Still, the biggest and most significant impact would be on all of those people who rely on the law for coverage; without the Affordable Care Act, the majority would almost certainly be without insurance, effectively reversing the law's impact.
Another finding of the new report is that the number of uninsured people in all 50 states and the District of Columbia has decreased dramatically as of 2019.
What Biden and the Democrats
Plan to Do Next
Of course, the century-long effort to make health care a right in the United States
, as it is in every other developed country, has a long way to go. Millions remain uninsured, and millions who do have coverage face high premiums or out-of-pocket expenses.
Changes to Medicare
that would add benefits such as dental and hearing, or open a version of the program to people as young as 55 or 60, are among the ideas now being discussed by Biden and the Democrats. There is also talk of new initiatives to cover low-income people in states such as Florida
, and Texas that haven't expanded Medi-Cal.
to finance either of these, or any other major expansions of insurance, is critical, and one way to do so would be legislation to lower drug prices, resulting in savings for both individuals and the government.
All of these ideas have been endorsed by Biden, and in theory, most Democrats support the entire agenda; however, each one comes with policy and political trade-offs.
With almost no votes to spare in either chamber and little prospect of meaningful Republican support, White House
officials and Democratic leaders in Congress are negotiating among themselves and with outside groups about what they believe they can accomplish.