Since the 2012 Supreme Court ruling upholding the Affordable Care Act, most people consider the ACA, and its many consumer protections, settled law. However, 18 states led by the Republican Attorney General of Texas, have sued again attempting to have the courts invalidate the health law.

The plaintiffs claim that since Congress zeroed out the penalty for not having insurance, the rest of the law is now unconstitutional, including coverage for people with pre-existing conditions and other popular consumer protections. In December 2018, the district judge sided with the plaintiffs, but his ruling did not go into effect because the decision was appealed.

This ACA case is back in court Tuesday July 9, and once again the fate of health law is uncertain. If the appeals court follows the previous judge’s ruling, all of the Affordable Care Act could be struck down without any plan ready to replace it. See this explainer from the Kaiser Family Foundation to dig into the specifics of this lawsuit

Wisconsin and the rest of the country have a lot to lose if the ACA were eliminated without a comparable replacement. According to an analysis from the Congressional Budget Office, 32 million people in the US would lose their health coverage including 200,000 from Wisconsin, if the ACA went away with no replacement.

Aside from providing health insurance to more than 200,000 Wisconsinites through the ACA Marketplace, the ACA includes many other popular protections that impact people covered by all types of health plans that many Wisconsinites rely on.

Protecting people with pre-existing conditions and requiring insurance to cover essential health benefits.

• All insurance plans on the Marketplace must cover treatment for people regardless of their health status. About one in four Wisconsinites have a pre-existing health condition; that’s 852,000 people – enough to fill the seats in Lambeau Field ten times over.
• The ACA requires that insurance plans cover care people may need, like hospitalization, mental health & substance use, emergency services, and prescription drugs.

Allowing kids to stay on their parent’s health plans through age 26.

• More than 41,000 young adults in Wisconsin have benefited from this rule.

Protecting people from annual and life-time limits.

• The ACA prohibits annual and lifetime limits on policies, so all Wisconsinites with employer plans and those on the Marketplace now have coverage there when they need it.

Helping to increase insurance coverage rates for people of color – particularly in Medicaid expansion states.

• Wisconsin saw broad coverage gains since implementation of the ACA. Despite increasing insurance coverage for all people, there are still substantial racial disparities in health insurance coverage between white people and people of color.
• For example, white Wisconsinites moved from a 7% uninsured rate in 2013 to 4% in 2017. During that same timeframe, Latinx Wisconsinites moved from an uninsured rate of 25% to 16%, and Black Wisconsinites moved from a 14% uninsured rate to about 7%. There is a lot of work left to do, but the ACA has helped and this progress could be at risk in Wisconsin and across the country if the ACA were repealed without a replacement.
• States that fully expanded Medicaid generally saw bigger gains in access to health insurance.

Increasing access to preventive care and screenings, like cancer screening, flu shots, and contraception.

• Private health plans, such as employer-sponsored plans, are required to cover a number of preventive care services for adults and children without any cost-sharing. In 2017, about 3.2 million Wisconsinites were covered through their employer.

Requiring insurance companies to spend 80-85% of their premium dollars on medical care and quality improvement.

• Thanks to the ACA, if insurance companies fail to meet this standard the insurance company must issue cash rebates to consumers.

The pending lawsuit threatens all these aspects of the Affordable Care Act. Read our 2018 report, Sabotage Watch to learn more about what the ACA has meant to Wisconsin.

A court ruling striking down the ACA would not only impact people insured through the ACA Marketplace, but would also affect people who have insurance through their employers. It would take us back to the bad old days when even if you had employer-sponsored coverage, they could bar coverage for treatment of “pre-existing conditions” for a year or more. It would also bring back “job lock,” where people were forced to stay in jobs for fear that their health conditions might not be covered if they switched jobs or started a business.

The ACA provides coverage for people with pre-existing conditions, makes health insurance more affordable for millions of US residents, helps to decrease racial disparities in who lacks health insurance, and prohibits annual and life-time caps. This is but a sliver of ways the ACA touches the lives of everyone and nearly every business in the US. Regardless of the appeals court’s decision in this case, it’s likely the ACA will end up back in the Supreme Court one more time, and Wisconsin and the rest of the country have a lot at stake.

William Parke-Sutherland