Is This the End of the Affordable Care Act?
As thousands of Americans finalized their health insurance plans for 2019 last week, a new ruling has put the future of the Affordable Care Act (ACA) in jeopardy.
On December 14, US District Judge Reed O’Connor sided with a group of 20 states with Republican governors and legislatures in deeming Obamacare unconstitutional in requiring Americans to secure health insurance. This, he said, was due to Congress stripping the tax penalty for the uninsured in 2017.
The US Supreme Court had ruled the ACA constitutional based on that individual mandate, but with the mandate gone, O’Connor wrote, so was the constitutionality of the law itself.
This does not mean that the law disappears right away—or perhaps ever. While the Trump Administration’s Department of Justice previously announced it would not defend the “individual mandate” to secure health insurance, others are likely to challenge the ruling. Numerous states with Democratic leadership intend to appeal O’Connor’s ruling, and the matter could head back to the Supreme Court.
In the meantime, those seeking coverage through state-based exchanges created by the law will continue to have coverage.
Doctors’ Passionate Pleas for Better Patient Care
Upon hearing the decision, more than 300 physicians made their voices heard in a post on Medscape.
The majority of comments expressed satisfaction at O’Connor’s decision to do away with Obamacare.
A number of physicians pointed out that, while good in theory, the ACA ran into problems when it became a reality after 2010. Said one neurologist:
Many ideas with noble goals have been failures when put into practice. The ACA is one.
Some self-employed physicians commented on the high premiums the law created, not only for patients, but for business owners.
One optometrist said:
The ACA forgot about small businesses, individuals, and others who are not living off the government dole. Our premiums have skyrocketed along with extremely high deductibles. There are parts of the plan that are good, but there are many aspects of this plan that need to [be] changed in a big way. If we are going to have a national health plan then EVERYONE needs to contribute; none of this only the middle class and rich will pay.
A number of physicians took exception to the American Medical Association’s (AMA’s) backing of an appeal as representative of the nation’s physicians. Said one internist:
I’m so glad the ACA was declared unconstitutional! Thank God! The medical organizations that oppose this latest Texas ruling are in my opinion no friend of mine, or [of] physicians in general, or [of] patients.
Added another physician:
The AMA is not speaking for most of us. The ACA is a disaster and until the AMA gets behind a fair market-based solution to health insurance, nothing good will happen.
If there was anything positive seen in the ACA by physicians it is protection for those with pre-existing conditions. However, as one ophthalmologist noted, the law was also flawed in that regard as well:
…[I]t put the companies that invented pre-existing conditions in charge of the system. Probably not a good idea except that lobbyists write the bill. We need a system where people like me can buy into Medicare and subsidize that system, with an adjunct not-for-profit insurance industry for those who can afford to pay more. This has to be done as a coordinated transition over time, not by simply terminating the ACA and trying to implement another system.
Another ophthalmologist summed up a number of comments, pointing out the high cost of the law for Americans and that rejection of the ACA as a law does not equate to support for insurers denying coverage due to pre-existing conditions:
In the past, there was agreement amongst both Democrats and Republicans that insurance carriers should not be able to hold these against potential members. So don’t make it seem as if a vote against the ACA is a vote against the pre-existing condition clause.
Despite Peer Objection, Some Support Remains
While many physicians commenting to Medscape were in favor of doing away with the ACA, there were still physicians who felt the law has helped US healthcare in the last several years.
Said one cardiologist:
Many of us are outraged by the exorbitant cost of health insurance: 18% of our GDP; 27% of our premiums going to insurers’ “administration” and bonuses. Yet, 22 million Americans can’t afford to see a doctor or health professional without the ACA. Something is wrong here—and it ain’t Obamacare…. Resist this ridiculous and un-American move to scuttle the ACA. Fix it but don’t let these politicians silence our voice. We are the stewards of healthcare.
Many who noted their objection to O’Connor’s decision felt similarly: not 100% behind Obamacare, but in favor of finding a solution before tearing it down.
One nephrologist said:
The law has problems no doubt. However before advocating to throw it out please give a solution to how pre-existing coverage problem can be resolved. You talk about people making bad health choices, but what about the person who gets lymphoma out of no fault of their own. Do they need to be penalized as having [a] pre-existing condition and not be able to get health insurance anymore or at unaffordable prices?
A fellow nephrologist added:
I’m embarrassed that there are physicians in this country who would do away with universal health care. The last thing we need is to increase the number of uninsured patients in this country. We should keep ACA and make changes to it that would decrease premiums and improve coverage.
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