There is clear evidence that the Affordable Care Act (ACA) is making a tremendous difference in the lives of tens of millions of Americans who are unemployed and in need of accessible quality health care during the COVID-19 pandemic.
In March the number of unemployed individuals rose sharply from 5.7 million to 23.1 million[1] and 17.1 million Americans filed for unemployment benefits[2] as state and local officials ordered bars and restaurants, offices, manufacturing plants, schools, gyms, and other public and private facilities to shut down in the wake of the sudden spread of the novel coronavirus.
By May 2, more than 33 million people had filed for unemployment insurance.[3] Of those, the Kaiser Family Foundation (KFF) estimated that as many as 27 million unemployed workers had lost their health insurance.[4] For many of those individuals, the only accessible or affordable health insurance was available through two federal programs: Medicaid (including Medicaid Expansion) and the ACA’s insurance marketplaces.
According to KFF, more than 21 million, or 77 percent of all Americans who were laid off, were eligible for either Medicaid (12.7 million) or an ACA insurance plan (8.4 million). Without these programs, millions of Americans would have had no way of paying for or accessing quality healthcare.
Unfortunately, six million Americans are not able to access either no cost or low-cost health insurance, and there appears to be no easy fix. This gap was created by states that chose not to take advantage of the ACA’s Medicaid Expansion program, even though their share of the cost would be low. Under Medicare Expansion the federal government paid 100 percent of the cost of coverage from 2014 to 2016, 95 percent in 2017, 94 percent in 2018, and 90 percent in 2020 and every year thereafter.[5]
The Medicaid Expansion was designed to fill the gap between regular Medicaid and ACA marketplace insurance programs. This ongoing gap in coverage — especially for lower income individuals and their households — required a fix, according to Democrats. In late June the House of Representatives adopted H.R. 1425, the “Patient Protection and Affordable Care Enhancement Act of 2020,” to help address this issue.
If H.R. 1425 were to become law, it would address the Medicaid/ACA gap in coverage by making subsidized or free health insurance and care available to those who currently cannot obtain coverage through Medicaid, Medicaid Expansion, or the ACA marketplaces. However, the chances of that happening are next to nil.
Republicans opposed the bill as another tax and spend effort by Democrats. Senate Republican leadership has indicated that they will not allow the bill to come to the Senate floor, while the White House issued a veto threat should the bill reach the president’s desk. Rep. Virginia Foxx (R-NC), the ranking member of the House Education and Labor Committee, called the bill “misguided” and argued that it would “contribute to already skyrocketing healthcare costs, and double down on the many failures of the Affordable Care Act or ACA.”[6]
At the same time, the administration has asked the Supreme Court to strike down the ACA as unconstitutional. If the Supreme Court agrees with the administration, the 28 million Americans who are covered by Medicare, Medicare Expansion, and the ACA would lose their benefits.
Without the ACA, 28 million Americans would have to rely on emergency rooms and other urgent healthcare facilities that are extremely expensive and are generally not able to address their individual, long-term healthcare needs. States and counties, generally the healthcare providers of last resort, would be saddled with the cost of healthcare for these 28 million Americans, placing further financial burdens state and local budgets that are already stretched thin due to the pandemic. Additionally, the loss of these health insurance programs would have the most negative impact Black and Latinx communities. It would substantially increase the healthcare disparities that already exist between people of color and their white counterparts. It would also contribute directly to the disproportionate number of coronavirus cases and deaths among people of color because of their more limited access to healthcare options.
Without the Affordable Care Act and its related programs, including Medicaid Expansion and health insurance through marketplaces, tens of millions of Americans would be without access to affordable insurance and quality healthcare. The failure to maintain or expand the ACA could have very negative consequences for all our communities.
[1] Bureau of Labor Statistics, February through July, 2020.
[2] Washington Post, U.S. now has 22 million unemployed, wiping out a decade of job gains, April 16, 2020.
[3] ABC News, 3.2 million more people file for unemployment, bringing coronavirus crisis total to over 33 million, May 7, 2020.
[4] Kaiser Family Foundation, Eligibility for ACA Health Coverage Following Job Losses, May 19, 2020.
[5] Center on Budget and Policy Priorities, Medicaid Expansion Continues to Benefit State Budgets, Contrary to Critics’ Claims, October 9, 2018.
[6] Committee on Education and Labor Republicans, Press Release: “Foxx Opposes Democrats’ Socialist Health Care Scheme,” June 29, 2020.