Endorsing his former vice president, Joe Biden, to win the White House, former President Barack Obama sought to contrast the 2020 platforms of Democrats and Republicans on a critical plank: their stance on the Affordable Care Act. It’s a difference, he argued, that has assumed newfound urgency.
“The Republicans occupying the White House and running the Senate … have shown themselves willing to cut millions off their health insurance and eliminate preexisting condition protections for millions more, even in the middle of this public health crisis,” Obama said.
Obama was referring to a couple of GOP policies, the former president’s senior adviser Eric Schultz told KHN. The first: a pending Supreme Court case, Texas v. Azar, in which the Trump administration has argued the 2010 health law should be struck down. Schultz also highlighted the White House’s refusal to provide a special open enrollment period for the ACA health exchanges in the midst of the coronavirus pandemic.
We’ve previously checked claims about President Donald Trump’s stance on the law’s preexisting condition protections — arguably its most popular component ― and his position on the Texas v. Azar lawsuit.
But COVID-19 adds new relevance, because of both the virus’s devastating health implications and bludgeoning impact on the American economy. Indeed, the Trump administration’s handling of the virus crisis is shaping up to be a defining issue in the run-up to November. Meanwhile, Biden made the health care law a signature component of his presidential platform and has been a vocal critic of the administration’s pandemic response.
With that in mind, we decided to take another look.
Obama is correct: The Republican Party has opposed the ACA for years. In 2016, then-candidate Trump campaigned on its repeal. Since then, the White House and congressional Republicans have pursued an agenda that would dismantle the law’s preexisting condition protections. Republicans haven’t united behind an alternative plan, either.
取消ACA可以消除以下规定：如果保险计划已存在，则该计划不能向人们支付更多费用；支出它为有人提供的在交易所购买保险的补偿，并取消可在六年内直接 扩大覆盖范围的医疗补助计划 超过1300万人。最高法院已同意审理此案，但要等到十一月大选之后才能裁决。
实际上，政府 甚至支持 各州应予以废除。白宫和参议员的建筑物，但拒绝支持这一法律-法律专家称此举几乎是史无前例的。共和党人都没有提出替代法案，以在高等法院裁定违法的情况下维持ACA的保护。
Americans who have lost their jobs ― and, often, the insurance that came with it — are eligible to buy insurance on the federal exchange, since job loss is a “qualifying life event” that gets you special access. Those who otherwise lack coverage would normally have to wait until the regular open enrollment period, which takes place at the end of the year. But the threat of COVID-19 has changed the risk for many of these potential shoppers.
In response, 11 states have independently reopened their state-run health exchanges for a special sign-up period. But the administration has declined to take such steps for the national marketplace.
“If you have been uninsured and picked up your newspaper, or turned on your news and realized your health was in much greater risk than you had anticipated, and would like to rush and get health insurance in case you end up on a ventilator ― you’re out of luck,” said Linda Blumberg, a health policy fellow at the Urban Institute, a nonprofit research organization.
Even before coronavirus, the institute estimated that 32 million Americans were uninsured. About 20 million of them could benefit from a special enrollment period, Blumberg said. Without insurance, coronavirus treatment poses not just a health risk, but also a financial one.
The Trump administration has said it will pay hospitals directly, out of a pool of $100 billion, to cover the cost of treating uninsured people with COVD-19. After treating patients, hospitals would get paid at the Medicare rate.
But the administration’s policy extends only to covering COVID-19 treatment. Uninsured people with underlying chronic conditions don’t have a way to pay for health care, noted Robert Berenson, another Urban Institute fellow. If left untreated, those chronic ailments make COVID-19 far more dangerous than it would be for someone able to get preventive treatment earlier on.
President Trump’s stance raises another question, experts noted. Without the ACA, what kind of impact would COVID-19 have?
Even with the heath law intact, many Americans won’t be able to find affordable health insurance. That particularly applies to people who can’t afford the premiums on the individual marketplace, don’t qualify for federal subsidies or live in one of the 14 states that didn’t opt into the ACA’s Medicaid expansion provision.
And the ACA is nowhere near sufficient on its own, Miller noted. Having insurance is part of the picture, but it doesn’t guarantee access to testing or that a hospital will be able to treat you. “On the margins, it does help a little bit to have insurance coverage, but the problem is so much larger than that,” Miller argued.
Still, without the health law, the virus’s impact would be “catastrophic,” said Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill.
凯撒家庭基金会副总裁拉里·莱维特（Larry Levitt）说，打击单个市场和扩大医疗补助将使大约2,000万人没有保险-“不仅有患COVID-19的疾病，而且还有大量医疗费用的风险。” （KHN是基金会的独立编辑程序。）
卫生法还对保险必须涵盖的范围进行了严格的规定。布伦伯格说，如果没有这些规定，计划可能会（而且很可能会）恢复到更 轻率的 范围。