On November 10, the U.S. Supreme Court heard oral arguments in a case that could up-end the country’s entire health care system. The case, California v. Texas, was brought by 18 states and the Trump administration. If successful, it would strip health care coverage from millions of Americans, including people approaching Medicare eligibility due to age or disability, reopen the Medicare Part D donut hole, end Medicaid expansion, and allow insurers to deny coverage and institute lifetime maximums on an estimated 133 million Americans with pre-existing conditions.
Two years ago, in a decision that received bipartisan condemnation, a federal judge in Texas found that the entire Affordable Care Act (ACA) is unconstitutional because Congress reduced the individual mandate tax penalty to zero. The Trump administration applauded this decision,and, on appeal, another court agreed with that initial decision. Now the case is in the hands of the Supreme Court and a ruling is likely in 2021.
Observers noted that the justices appeared dubious about the arguments put forward by the plaintiffs, so there is some hope that they will preserve all or most of the ACA. But given the COVID-19 public health emergency, the stakes have grown even higher.
Elimination of the ACA would immediately end Medicaid expansion and would allow individual and employer-based plans to discriminate against people with pre-existing conditions—including those suffering the after-effects of COVID-19.
In addition, there would be significant cuts to Medicare. The ACA extended coverage for preventive care services and eliminated the Part D prescription drug donut hole. This has saved people with Medicare millions of dollars. In addition, the ACA prohibits Medicare Advantage plans from imposing higher cost-sharing on chemotherapy, renal dialysis, skilled nursing care, as well as other services, to prevent them from discouraging higher cost patients from enrolling in their plans. Undoing these improvements would adversely affect the health and economic security of Medicare beneficiaries.
There is reason to be hopeful about the outcome of the case, but justices are not bound by observers’ impressions. Because the health, well-being, and economic security of millions is at risk, we must be aware of the danger that may be looming.
At Medicare Rights, we urge states and the federal government to work to ensure high-quality health care and coverage for everyone. If successful, this frivolous lawsuit would have the opposite effect, with devastating consequences.