The artwork on this note card was created by 5768 WRJ Art Calendar artist Césan d’Ornellas Levine.
In 2009, a person who had suffered from an illness in the past could be denied health coverage based on that preexisting condition. In 2009, a woman could be subject to higher insurance costs exclusively due to her gender. In 2009, a low-income family that did not qualify for Medicaid, and did not receive employer-based insurance, was likely to be uninsured. Before the Patient Protection and Affordable Care Act (ACA) passed in 2010 and was implemented fully in 2014, the health insurance system in the United States left over 47 million Americans without coverage. Few pieces of legislation in the last 50 years have had a greater effect in the daily lives of Americans than the ACA.
Beginning in January 2017, much of that progress will be at risk.
Members of Congress and the incoming Administration are threatening to repeal major pieces of the ACA. This alone would be troubling, but it is especially worrisome given that some are suggesting repealing the health care law without a comprehensive replacement mechanism. A recent study by the Urban Institute indicates that 30 million people could lose their coverage in this scenario.
To understand how this is possible requires knowledge of how the ACA currently functions. The legislation contains three primary mechanisms for increasing coverage: 1) Federally-funded Medicaid expansions in states that have agreed to implement the expansion and accepted funds; 2) Marketplaces for individuals buying coverage with tax credits for the majority of its users; 3) The individual and employer mandates for buying and providing insurance. The Center on Budget and Policy Priorities breaks down how all three of these work together to increase coverage.
The ACA’s provisions may seem complicated, but the results are clear: public and private healthcare coverage has increased dramatically in every state. In addition to these coverage expansion mechanisms, the ACA included many regulatory reforms that have had substantial effects on the healthcare industry. Two of the most popular and well-known of these changes are the ban on discrimination against people with preexisting conditions and the ability for children under the age of 26 to remain on their parents’ insurance plans.
A deeper understanding of how the ACA works clarifies the ways in which it can be changed. Members of Congress who wish to repeal the ACA will likely use a process called budget reconciliation. The process is a parliamentary procedure that allows Congress to pass limited legislation related to the budget with only 51 votes in the Senate. It is the same procedure in which major portions of the ACA were originally passed. Budget reconciliation will limit the extent of ACA repeal that is possible, which will likely mean that many of the bill’s regulatory changes will stay in place. But the employer and individual mandate, Medicaid expansion, tax credits for the private marketplace, and the taxes that help pay for the ACA could all be repealed through reconciliation.
ACA repeal would particularly affect many low-income families. The bill has disproportionately helped the most vulnerable populations, and a repeal could mean serious ramifications for many families with few alternatives. On the flip side, ACA repeal would amount to an enormous tax cut for families making more than $200,000, as well as insurance companies.
The possible repeal of the ACA is a gravely concerning matter, but should not obscure the reality that the bill is imperfect. Rising premiums and lack of marketplace competition are two of the largest challenges the current system faces. Economists, healthcare experts, journalists, and many others have a variety of ideas for changes to the ACA that would improve affordable access. But the evidence demonstrates that without a viable replacement plan, ACA repeal would amount to an enormous setback for millions.
Reform Jewish values make it clear that health care should not be a privilege, but a right. For centuries, Jewish law has commanded communities to provide healthcare to their inhabitants (Mishneh Torah, Hilchot De'ot IV: 23). We learn that healthcare is a core element of creating a society of equality and justice. Leaving millions of people without healthcare would undermine years of progress and an important measure to lift up the most vulnerable among us. We must take action to preserve this important legislation.
Luckily, there are ways you can make a difference on this issue and make it clear that you will not stand for ACA repeal without replacement, which would leave millions in the dust. Send a letter to your member of Congress explaining why this issue is important you, and call your Senators to make your voice heard. For more on this issue, visit the RAC’s healthcare page, or check out the RACBlog. You can also contact Eisendrath Legislative Assistant Nathan Bennett at (202) 387-2800.