Originally published in Capitol Weekly – September 25, 2020
Justice Ruth Bader Ginsburg’s death has placed the future of the Affordable Care Act (ACA) back in the headlines because the Supreme Court is scheduled to hear arguments in November in a case, California v. Texas, that seeks to repeal it.
The widely publicized prospect of eliminating health care coverage for more than 20 million Americans during the COVID-19 pandemic should be enough to give our elected leaders and the high court pause. But often overlooked in this debate is how ingrained the ACA has become in our nation’s and our state’s health care system since its adoption in 2010. The ACA has transformed funding, priorities and the capacity of the nation’s health care system in ways that would be extremely difficult and time-consuming to unravel, especially now.
Its repeal – without a meaningful replacement – could create chaos in a health care system already grappling with the pandemic.
Among its many changes, the ACA increased funding in the Community Health Center Fund, which made possible the expansion and enhancement of community health centers, like ours, that provide care to 1 in 11 people in the U.S. by serving the nation’s most vulnerable.
Hospitals and other medical providers also benefitted. A 2017 study found that the uncompensated care costs fell sharply in states that expanded Medicaid (Medi-Cal in California) under the ACA. The study estimated $6.2 billion in savings, with the largest savings in states, like California, where the ACA provides coverage for one in three residents through Medi-Cal.
For our clinic, ACA’s expansion of Medi-Cal meant the percentage of our patients with health insurance more than tripled. That led to more than an 80% increase in investments in health care programs and services, including the expansion of dental and mental health services and on-site pharmacies. Since the ACA was fully implemented, the number of patients we serve has increased by 34%.
Continuing Medi-Cal’s expansion is even more critical during the pandemic because the people it serves often live in lower-income communities, which are suffering higher COVID-19 infection rates and deaths. Loss of Medi-Cal could also cause them to forgo preventive measures, and that would lead to other serious illnesses, deaths and higher costs than if the disease or condition had been prevented or detected earlier.
The ACA’s provision requiring insurance plans to cover young adults on their parents’ medical plans up to age 26 is even more important today because younger Americans have suffered far greater COVID-19 job losses – and the loss of employer-provided insurance – than their parents.
The ACA also protects Americans with pre-existing conditions, who are the most at risk for serious illness and death from COVID-19. It requires insurance companies to cover people with pre-existing conditions and prohibits charging them more for those conditions.
All health plans also must provide essential benefits, which include substance use treatment and mental health coverage. With the pandemic creating additional stress and isolation, some researchers have predicted higher rates of substance use and mental health issues among the public. Even before the pandemic, more than a fourth of patients with serious mental illness relied on Medicaid nationwide (Medi-Cal in California), so its expansion under the ACA played a critical role in providing mental health services and substance use treatment to Californians, including people experiencing homelessness.
Under the ACA, the federal government also started pushing health care providers to improve the quality of care. This led to basing some federal payments on patient outcomes — rather than basing payments on the procedures that were performed – and on the use of preventive strategies, like improving access to healthy food.
At Venice Family Clinic, for instance, we expanded preventive care to include educational programs, such as exercise classes, diabetes management courses and a culturally sensitive Teaching Kitchen, where, before the pandemic, we helped patients prepare simple and healthy meals using affordable and locally available ingredients.
While it has many benefits, the ACA is not perfect. More needs to be done to ensure everyone has access to affordable and comprehensive health care. COVID-19 has made it clear that the health of each person – regardless of their income, immigration status or insurance coverage – helps determine the health of all persons.
But like it or not, the ACA has become the backbone of our current health care system – from our community health care centers to our nation’s largest hospitals. To overturn it now is the wrong prescription for healing a nation where 200,000 people have already died from COVID-19.
Editor’s Note: Elizabeth Benson Forer is the CEO of Venice Family Clinic, a Los Angeles community health center celebrating 50 years of providing quality primary health care to people in need, regardless of their ability to pay or immigration status.