Killing Obamacare Would Upend Health Care System


By Frank X. Mullen

When the Patient Protection and Affordable Care Act went into effect in 2014, more than 20 million uninsured Americans gained health coverage. The ACA withstood multiple attempts at repeal, but now that the Department of Justice will no longer defend the law in court, the ACA may be struck down with a gavel instead of legislative fiat.

If the courts negate Obamacare, the effect on the nation and Nevada would be sudden and catastrophic, health care insiders say. Many people would be worse off than they were before the overhaul went into effect and insurance markets would be thrown into chaos.

“You don’t want to see (the demise of the ACA) without some sort of comprehensive replacement,” says Phil Conjesco, an insurance agent from Las Vegas . “There are problems with high premiums and getting coverage in rural areas now, but if the law went away completely, the whole insurance market would suffer.”

He says in addition to the millions who would be left without policies, people with private insurance would face reductions in coverage and rising premiums. “The fragmented market would be turned into the Wild West and it would have a ripple effect,” he says. “You can’t just pull the rug out from under one-fifth of the economy and expect that won’t cause big problems.”

A Texas judge has declared the ACA unconstitutional, a decision that probably will be appealed all the way to the Supreme Court. Is it likely the high court will trash Obama’s signature accomplishment?

Fred Lokken, professor and chair of the Political Science Department at Truckee Meadows Community College in Reno , notes the Supreme Court previously upheld the bulk of the ACA. He gives the law a better than even chance of surviving.

“I make the odds 60 to 40 to uphold the ACA,” Lokken says. “The Supreme Court usually doesn’t want to take any actions that would render immediate harm.”

There’s little doubt that revoking the law would throw millions off their health insurance. By 2016, two years after the ACA went into effect, between 20 million and 24 million people gained coverage, cutting the uninsured share of the U.S. population in half. That was due to an expansion of Medicaid eligibility and to major changes to individual insurance markets.

If the court strikes down Obamacare, at least 20 million low-income adults would lose their health insurance, including about 12 million now covered under the Medicare expansion. Insurance companies would be free to deny coverage – or sharply raise premiums – for people with pre-existing conditions. Young adults would no longer have the right to remain covered under their parents’ insurance plans until they turn 26, a situation affecting about 3 million people. The law’s guaranteed access to “essential health benefits,” including prescription drug coverage, maternity care and mental health/substance use benefits would no longer apply. Insurance companies would again be able to set lifetime and annual limits on how much care they will cover for individuals and families.

If the law is struck down, the 211,000 Nevadans now covered by the state’s expansion of Medicaid, including 13,000 children and about 60,000 adults would loose coverage, according to state government estimates. In a media call in March, five state governors, including Nevada Gov. Pete Sisolak, called the Trump Administration’s attempts to kill the ACA “heartless and cruel.”

“If the ACA were completely dismantled, it would have disastrous and sweeping consequences for Nevada ’s entire health care system and leave hundreds of thousands of Nevadans twisting in the wind,” says Sisolak in the call hosted by the Democratic Governors Association. “Those enrolled in private insurance plans, Nevadans covered under Medicaid expansion, as well as young adults on their parents’ plan and those with pre-existing conditions would all feel the immediate devastating impacts.” He notes that at least 25 percent of Nevadans under the age of 65 have pre-existing conditions.

In addition, the state’s economy would suffer, according to an analysis by the Economic Policy Institute, an independent, nonprofit think tank that researches the impact of economic trends and policies. The institute estimates that if the ACA were struck down or repealed. 16,000 jobs would be lost statewide, and Nevada would lose $1.3 billion in federal healthcare dollars.

“As long as I’m governor, the state of Nevada will continue to fight against the radical and dangerous attempts to rip away health-care coverage from millions of Americans and throw our health-care system into total chaos,” Sisolak says.

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