Your health insurance might be on the chopping block

Too bad there is not another presidential debate this week. The moderator would be able to ask the most important question of our time: When it comes to a comprehensive health insurance program, which is better: ObamaCare or what the Trump administration has proposed to replace it with? 

It’s a trick question, because to date, after four years of promising a better health insurance plan, there is no Trump administration plan.

The Affordable Care Act (ACA), better known as ObamaCare, which passed in 2010, extended coverage to millions of uninsured Americans by expanding Medicaid. Thirty-nine states have since elected to expand eligibility. For others not covered by their employer’s plan, new health insurance exchanges were created to allow individuals to buy health insurance.

Additionally, the ACA set federal standards for health insurers that offer plans to individuals, small groups as well as employer-sponsored health benefit plans.  For the first time, these standards under current law prohibit insurers from: 1) denying coverage to those with pre-existing conditions; and 2) excluding adult children up to age 26 from their parents’ plan. 

Donald Trump vowed to repeal the ACA and replace it with something better.  Trump has asked Americans to trust him to do this rather than developing or proposing an insurance alternative. Instead he has issued executive orders that apply only to people who already have health insurance (e.g. permitting states to pursue lowering drug costs and expanding the kind of health expenses that can be deducted from one’s health savings account; expanding access to telehealth). 

Promising to protect pre-existing conditions by itself is a hollow promise especially to the 54 million people the Kaiser Family Foundation estimates have conditions serious enough to be denied coverage if the ACA were not in effect. And if COVID-19 patients experience long-term health conditions, it’ll mean more individuals will not be able to get health insurance unless pre-existing conditions are required to be covered.

Likewise, repealing elements of the ACA does not afford access to health care, unless, at the same time, it is replaced with a law granting access to health insurance for the millions of Americans currently covered.

Instead, the Trump administration has shortened the time period in which people are allowed to purchase insurance from an exchange and withheld subsidies to support said purchase for low-income individuals. They have also tried to eliminate the penalty for individuals not buying health insurance — the basis for the current lawsuit to be heard before the Supreme Court on November 10, which, depending on how it is decided, could lead to the elimination of the entire ACA. 

The death of Justice Ruth Bader Ginsburg means the Supreme Court will have a smaller liberal wing when it hears the latest ObamaCare challenge. Ginsburg voted twice to uphold the ACA’s constitutionality and was widely expected to hold that position in the upcoming case. If Judge Amy Coney Barrett is confirmed to the court, the jury is out on how she would vote on the November challenge to ObamaCare. Her earlier writings demonstrate sympathy for attacks on the ACA.

Aware of how important health insurance is to Americans, Republicans have tried to spin their non-existent health insurance plan. Although they have promised to protect pre-existing conditions, there is no national plan to do so. In fact, what they propose is to give states the power to decide which “essential health benefits” to cover, and to remove the ban on annual and lifetime limits on covered benefits and the requirement to cover some preventive services for free. Block grants to the states and relying on religious based health insurance ministries would be their panacea: neither of which ensure nationwide access to health insurance for all Americans.

So, as November 2020 comes upon us, health care issues are dominating our lives. The COVID-19 pandemic rages on, a Supreme Court case to fully repeal ObamaCare comes to the fore, and a presidential election is well underway with health care being a central concern of U.S. voters. 

At stake right now is the future of the Affordable Care Act, and the degree to which Republicans have anything to replace it, or how their revisions might undermine it. How the Supreme Court votes, how Americans vote and how the current administration handles health care could mean the difference between life and death, between health care-related individual debt and longevity. It could also reshape how our children and grandchildren access health care in the future. 

Access to health care is hanging in the balance. This really is an existential moment. Whether through the courts or through the ballot box, we need to protect access to health care, especially for the most vulnerable among us. This is not the time to play around with life and death.

Tara D. Sonenshine is former U.S. under secretary of state for public diplomacy and a fellow at the George Washington University School of Media and Public Affairs. Patrice Hirsch Feinstein is the former associate administrator for policy of the Health Care Financing Administration under President Ronald Reagan.