As the fate of the Affordable Care Act rests in the hands of a federal court in Texas, some experts fear the law’s benefits to young people over the years could come undone.
Earlier this year, Gov. Scott Walker approved a request by Attorney General Brad Schimel to join 19 other states in a lawsuit declaring the landmark 2010 healthcare law unconstitutional.
The central supporting provision of the ACA used to be the individual mandate, which was repealed by Congress late last year.
The mandate acted as a penalty tax on individuals without health insurance, encouraging healthy, mostly young people to buy coverage. Those funds would financially support the law’s protections of costlier patients, like those with preexisting conditions and of older age.
“[The states] are claiming that [the ACA is] not legal because once the individual mandate was struck down, the powers that made it possible for the federal government to have this law disappeared since there’s no longer a penalty if you don’t get insurance,” UW-Madison law professor Sarah Davis said.
The attorney generals of these states asked the court to, at a minimum, strike down pieces of the law that prohibit insurance companies from refusing coverage to people with preexisting conditions or charging them at higher rates.
Experts estimate that between 25 and 50 percent of the population have what’s considered an “excludable health condition,” which could be as serious as a chronic disability or as mild as asthma, but could regardless incur higher costs from insurance companies without protections like those in place under the ACA.
State Republicans have floated pairing the lawsuit, if successful, with protections to replace the ones under the ACA, including establishing what are known as high-risk pools, something that Wisconsin had in place prior to the 2010 healthcare law. But there are concerns about both the breadth and depth of such programs.
“We had a very well functioning high-risk pool, but at its peak it had about 20,000 people enrolled, and that’s compared to 200,000 that are currently enrolled on Obamacare policies in our state,” said Donna Friedsam, director of the UW-Madison Health Policy group. “The high-risk pool was pretty expensive for people, and a lot of people found that they couldn’t get or afford coverage for their specific conditions.”
At the lawsuit’s widest scope, it could dismantle the ACA almost entirely.
“In some sense, it’s brilliant from a theoretical standpoint,” Davis said. “You knock one thing down, and then you use that as the argument for why the rest of the law has to fall.”
In that situation, the groups most impacted by the ACA would face a new reality, one without both the penalties and protections they currently enjoy under law.
Young people nationally have utilized one of the ACA’s most popular provisions: allowing children to stay on their parents’ insurance up to the age of 26, a law Wisconsin already had in place, but that the ACA codified nationally.
Without the federal law, Wisconsin’s youth would retain that provision, but the kind of insurance they receive could change drastically with that of their parents.
Young people, who tend to be much healthier, would also likely go back to purchasing insurance at a much lower rate than other groups.
Without the ACA, young people, who generally rely on health insurance, would no longer be forced to buy in, therefore driving up costs for people who are more vulnerable to illness.
“In the short term, if these suits are successful, it might make health insurance less expensive for college students and young people, but that is on the backs of sicker and older people,” Davis said. “It’s not sustainable to have people pay much less when they’re young and healthy and much more than they can afford when they’re sick.”
