US Politics

Will I lose my health insurance if Obamacare is repealed?

Now 10 years old, the Affordable Care Act is in danger. On 10 November a Supreme Court hearing could result in its demise. How would it affect you?

Will I lose my health insurance if Obamacare is repealed?
JOSH EDELSON AFP

The Supreme Court hearings to confirm the nominated Justice Amy Coney Barrett, replacement for the late Ruth Bade Ginsberg, have focused in large part on whether her appointment before 10 November would tip the court to a majority in favour of abolishing Obamacare. Coney Barrett has in this week’s hearings consistently refused to answer whether she wants to repeal the Affordable Care Act (ACA).

If Barrett gets appointed and Democrats’ worst fears come true, we know that millions of Americans could lose their healthcare, but exactly who are those millions?

How many people does Obamacare protect right now?

It’s estimated that 133 million Americans have pre-existing medical conditions that could disqualify them from buying health insurance or see them paying much higher premiums if ACA were overturned, according to a government analysis done in 2017.

The Kaiser Family Foundation estimated that 54 million of these have conditions serious enough that insurers would deny them coverage if Obamacare were not in effect, according to an analysis it did in 2019.

Talking to CNBC Ben Sommers, professor of health policy and economics at Harvard University said that there is “really no portion of the health-care system that isn’t impacted” by Obamacare, which means overturning the whole law without a replacement proposal could create “chaos and confusion” in the system.

What difference does Obamacare make to coverage for individuals?

The Affordable Care Act, when first signed into law by Barack Obama in March 2010, expanded and improved health insurance in two key ways:

  • Firstly, the number of insured individuals increased by expanding access to Medicaid coverage. Subsidies were also provided to purchase private insurance.
  • And second, Obamacare upgraded the quality and scope of coverage by improving benefit design, including implementing the “essential health benefits”, which the ACA required all individual and small-group market plans and health care exchange plans, to cover.

Under the ACA, health insurance companies cannot deny coverage or charge higher premiums based on a person’s medical history. In addition to this, policies cannot exclude coverage for treating a pre-existing condition, must include limits on out-of-pocket spending, cannot include limits on annual or lifetime coverage, and the majority of cases (but not all) must cover essential health benefits (more on these below). Repealing Obamacare would potentially take away all of these safeguards.

According to The New York Times, there are 23 million people who either buy health insurance through the marketplaces set up by the ACA (roughly 11 million) or receive coverage through the expansion of Medicaid (12 million).

Of these 23 million, about 21 million are at serious risk of becoming uninsured if Obamacare is abolished. That includes more than nine million who receive federal subsidies.

These subsidies on average cover $492 of a $576 monthly premium this year, according to a report from the Department of Health and Human Services. If the marketplaces and subsidies go away, a comprehensive health plan would become unaffordable for most of those people and many of them would become uninsured.

What are Essential Health Benefits?

Essential Health Benefits are a set of 10 categories of services health insurance plans must cover under the Affordable Care Act.

These are doctors’ services, inpatient and outpatient hospital care, all basic pediatric services (inc. eye tests and dental), prescription drug coverage, pregnancy and childbirth, mental health service, preventative medicine and chronic disease management, rehabilitation and laboratory screenings and tests. Dental benefits for adults are optional.

This basically means that without Obamacare, once again these “sssentials” like mental health services and pregnancy could be considered non-essential, premium services, for which individuals have to pay extra to be covered.

So who stands to lose their coverage if ACA is repealed next month?

  • Any young adults who have coverage through their parents’ plans. Obamacare required employers to cover their employees’ children under the age of 26. It proved really popular, and in 2016 the government estimated that two million young adults were covered under a parent’s plan. If the ACA was repealed, it would be up to employers to decide whether to keep offering this coverage.
  • Anyone who gained healthcare anew through the ACA’s expansion of Medicaid . This includes at least 12 million low income adults at or below 138% of the federal poverty level (which in 2020 means if you earn less than $17,236 you’re entitled to subsidised insurance under Obamacare’s Medicaid expansion). What’s more, according to The Urban Institute enrolment in Medicaid would drop by 15 million which includes approximately three million children who got Medicaid or the Children’s Health Insurance Program when their parents signed up for coverage. Thirty-six states and D.C. have adopted Medicaid expansion and 14 states have not.
  • Anyone with pre-existing conditions could potentially lose their coverage. Repeal of Obamacare would allow insurance companies to deny coverage for people with pre-existing conditions or charge higher premiums, making it difficult for many to afford coverage.
  • Anyone who requires expensive treatment. What Obamacare did for sufferers of ongoing illnesses that cost a pretty penny to treat, was remove the yearly or lifetime caps that insurance companies can put on an individual account. Without the ACA, 165 million Americans with conditions such as cancer or haemophilia could face extortionate out-of-pocket bills once their medical expenses reach the cap. Of course, the majority of people don’t ever reach these caps anyway, but those who do often face the impossible choice between bankruptcy or stopping essential treatment.
  • Anyone currently getting opioid addiction treatment through Medicaid, which according to the KFF is 40% of people ages 18 to 65 with opioid addiction, or 800,000 people. Access to Medicaid has been proven to double the likelihood that an adult will seek treatment for addictions, compared to uninsured adults.
  • Anyone affected by any one of the 10 essential health benefits mentioned above, your insurance cover could change, get more expensive or even become invalidated.

What counts as a pre-existing condition?

Pre-existing medical conditions can be anything from common ailments as high blood pressure, asthma, acne, anxiety, diabetes, sleep apnea and obesity as well as more serious illnesses like depression, epilepsy, heart disease, cancer, past surgeries and so on. Any one of these and hundreds more could require those buying insurance to pay much more for a policy, if they could get one at all.

Over seven million Americans have now been infected with covid-19, in many cases causing long term complications. This could well be added to the long list of pre-existing conditions which make it a challenge to find affordable insurance.

What if I’m insured through my work or a federal program?

If you’re not buying your insurance on an individual basis, you would still be able to get coverage under a plan provided by an employer or under a federal program. However, protections for pre-existing conditions are especially important during an economic crisis or to those who want to start their own business or retire early. Before Obamacare, employers would sometimes refuse to cover certain conditions. Should it be abolished, companies would be able to decide if they’d drop any of the conditions they are now required to cover by law.