New America Media, Commentary, Linda Leu and Anthony Wright
Many Americans wonder what the Republican takeover of the U.S. House of Representatives or the various legal challenges and court rulings will mean for the federal health law passed earlier this year—including the new consumer protections, benefits and options that many families have been anxiously awaiting or have already begun to rely upon. Some of these threats are in fact, threatening. But others have little chance of ever coming to pass.
The key fact is that the Affordable Care Act (ACA) is now the law of the land, and even with their electoral victories, opponents of health care reform lack the power to repeal the law. Of particular note, the consumer protections that started to take effect this year—from prohibiting insurers from canceling coverage when someone gets sick, to eliminating co-payments for preventative care—will continue.
While there are some areas of concern, seniors need not fear that they will lose their $250 prescription drug rebates. Young adults who have recently gained coverage under their parents’ plans need not fear becoming uninsured again. People previously denied coverage due to their health status need not worry that the new pre-existing condition insurance program (PCIP) option will disappear. Small business owners can rest assured their tax credits for providing health care to their workers are safe.
Nonetheless, here is a look at some of the threats to the ACA and an assessment of how worried consumers should be.
Congressional Repeal: With the Republicans winning a majority in the House, they will likely act quickly to pass a bill seeking to repeal ACA. The bill will make a big splash in the headlines, then stall in the Senate, where the Democrats still hold sway. A complete repeal of the bill would mean an increase in the federal deficit, which would be politically unpopular. Without the real possibility of repeal, the health care reform law will remain the law, and newly enacted consumer protections will remain intact. The possibility of a full repeal is dependent on the results of the 2012 presidential elections; without a change in party, repeal won’t happen.
Congressional Oversight: The House GOP can use its oversight authority to bury the Department of Health and Human Services (HHS) in investigative hearings and try to distract the agency from the work of implementing the ACA. However, though HHS plays an important role, most of the work to implement the law will need to be done by the individual states.
Defunding: Republicans have threatened to hobble the ACA by refusing to appropriate any money to help the law take effect. But most of the funding needed to implement the law does not require congressional approval. Nor can Congress take away funds for expanding Medicaid or creating state insurance Exchanges. That said, a showdown is likely in those areas that need Congressional approval—from funding for consumer assistance programs, to investments in prevention and public health, to pilot programs aimed at reducing the cost of health care. These programs need active support to continue in the next Congress.
Judicial Challenges: The majority of the legal challenges to ACA have been dismissed, but there are a few still making their way through the courts. A Republican-appointed judge in Virginia ruled on Monday that the ACA’s requirement that individuals must have coverage is unconstitutional—but he allowed the rest of the law to stand. The ruling will be appealed, and if it is upheld, the ACA can be fixed to deal with the legal issues. California reformers remember that Healthy San Francisco, a version of health care reform for low- and middle-income residents of that city, was struck down by the first court that reviewed it, but eventually upheld by the U.S. Supreme Court. Until the Supreme Court weighs in, implementation of the ACA will continue.
State Cooperation: Gubernatorial elections that resulted in victories by opponents of the federal health law do pose a threat to the ACA. States have considerable leeway to implement the ACA; in the name of ideology, they could even refuse federal dollars meant to provide health care to their residents and to benefit their doctors, nurses, hospitals, and clinics.
California has not had this problem. Voters re-elected every congressional representative who voted for the ACA, as well as a new governor and attorney general who have pledged to fight for it. California has moved forward aggressively, passing some of the first bills in the nation to implement and improve upon the federal law.
The bottom line is this: California’s families should disregard most of the political theater in Washington D.C. and see how health care reform benefits them. With a disproportionate share of uninsured Americans, and a health care system at a breaking point, California needs all the help it can get. California voters should take advantage of the new benefits and options under ACA—and continue to press our elected leaders to seize the opportunities available for our state.
Linda Leu is a health care policy analyst at Health Access California and Anthony Wright is the organization’s executive director.