Q&A: Overturning 'Obamacare' during a pandemic

RICARDO ALONSO-ZALDIVAR
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Healthcare professional Kenzie Anderson takes a sample from a patient at a United Memorial Medical Center COVID-19 testing site Friday, June 26, 2020, in Houston. The number of COVID-19 cases continues to rise across the state. Texas Gov. Greg Abbott has said that the state is facing a "massive outbreak" in the coronavirus pandemic and that some new local restrictions may be needed to protect hospital space for new patients. (AP Photo/David J. Phillip)

WASHINGTON (AP) — The decade-old health care law that has divided Americans even as it expanded coverage and protected people with preexisting conditions is being put to yet another test. Amid a pandemic, President Donald Trump and some red states want the Supreme Court to declare the Affordable Care Act unconstitutional. Blue states and the U.S. House say the case has no merit.

Here are questions and answers as the case unfolds:

WHAT HAPPENS NOW?

In the real world, very little will change right away. Politically, it's another story.

It’s unclear if the court will hear oral arguments before the November election. A decision isn't likely until next year, which means the ACA stays in place for the foreseeable future.

Even if a Supreme Court majority comes down of the side of “Obamacare's” opponents, unwinding the 10-year-old law would be time-consuming and fraught with political risk. Many of the ACA's provisions are popular, such as guaranteed coverage for people with preexisting medical conditions, and birth control coverage for women free of charge. Others are wired into the health care system, like changes to Medicare payments and enhanced legal authority against fraud.

In the political realm, Trump's unrelenting opposition to the ACA energizes Democrats going into the November elections.

As if on cue, House Speaker Nancy Pelosi has rolled out a bill to expand the health law, and the House is expected to vote on it Monday.

The goal isn't so much to pass legislation, since Pelosi's bill won't get a look in the Republican-controlled Senate. But it may make some Republicans squirm by forcing them to cast a vote their Democratic opponents can use in campaign ads this fall.

“God willing the courts will do the right thing, but we just don’t know,” says Pelosi. “So we are getting prepared for what comes next.”

HOW IS OBAMACARE DOING UNDER TRUMP?

Remarkably well, despite dramatic pronouncements by politicians on both sides.

Larry Levitt of the nonpartisan Kaiser Family Foundation estimates that about 23 million people are covered under the law, about the same as when former President Barack Obama left office.

That includes about 12.5 million covered under Medicaid expansions in most states and some 10 million through health insurance marketplaces like HealthCare.gov that offer individual plans subsidized by the taxpayers.

According to Gallup, Americans under Trump have either tilted in favor of the ACA or been closely split. By contrast, during Obama's last term, the public more often tilted against the law. Fifty-two percent approved of the ACA in March, while 47% disapproved.

A turning point came when Trump and a GOP Congress failed to repeal Obamacare in 2017.

DOES THE ACA MAKE ANY DIFFERENCE IN THE COVID-19 PANDEMIC?

It has taken on a new role. Coverage through the ACA can be a lifeline for people who lost their health insurance as a result of layoffs.

The Kaiser Family Foundation estimated recently that nearly 27 million people lost employer coverage because of pandemic-related layoffs, and nearly 80% would be eligible for Medicaid or an Obamacare plan with subsidized premiums.

New government numbers show HealthCare.gov enrollment has grown by about half a million people amid the pandemic.

WHAT WOULD HAPPEN TO PROTECTIONS FOR PEOPLE WITH PREEXISTING CONDITIONS?

That's a source of anxiety for many Americans.

A Kaiser foundation poll in January found that 57% are worried that they or someone in their family will lose health insurance if the Supreme Court overturns the ACA's protections for people with preexisting conditions. Under Obamacare, insurers cannot use someone's medical history to turn them away or charge them more.

The Trump administration has argued in court that the law's constitutional flaws would also entangle its protections for people with preexisting conditions.

Yet Trump has promised he would preserve those safeguards, without laying out a plan for how he would do that.

Some prominent Republicans say they never intended to undermine protections for people with preexisting conditions when they voted to repeal Obamacare's unpopular fines on people going uninsured. That repeal is the root cause of the current court case, since the law's opponents argue that without the fines the entire statute is rendered unconstitutional.

Traditionally, Republicans have supported protections for people with preexisting conditions, but with a limitation that individuals have to keep up their coverage to qualify.

WHERE’S JOE BIDEN IN ALL OF THIS?

He's backing his former boss' signature legislation.

The Democratic presidential candidate says if elected president he would build on the ACA to move the nation closer to coverage for all. Biden would increase the health law's subsidies for individual private plans, finish its Medicaid expansion, and create a new “public option” alternative modeled on Medicare.

HOW IS THE U.S. DOING ON ACCESS TO HEALTH INSURANCE?

Under Trump, the uninsured rate had started inching up again. The economic shutdown to try to slow the spread of coronavirus is likely to have made things much worse, but government numbers aren't available to quantify the impact.

The Census Bureau reported last year that 27.5 million people, 8.5% of the population, lacked health insurance coverage in 2018. That was an increase of 1.9 million uninsured, or 0.5 percentage point, from 2017.

It's not clear how many people who lost employer coverage in the pandemic have wound up uninsured.