There is an outpouring of Angst about the prospect that the Fifth Circuit Court of Appeals might rule the Affordable Care Act unconstitutional—or dismiss the appeal because the Trump Administration declines to defend the law and California and other intervenors lack standing. Then the District Court decision by Judge Reed O’Connor would stand, and ACA would fall.
For example, the AMA complains that hundreds of millions would be at risk of losing “coverage.” In fact, only a net 1.7 million people gained private coverage under ACA, after subtracting the nearly 6 million who lost it, at a shocking cost of $341 billion or $200,000 per newly insured person. Most of the claimed increased coverage came from expanding Medicaid to childless, able-bodied adults. This reduced access to services by the sickest patients, and at least 21,904 patients died on Medicaid waiting lists according to a 2018 report.
Without ACA and its unaffordable requirements, Americans would have many more options to buy affordable insurance. Instead of paying as much as a mortgage payment for “coverage” they are unlikely to use, they might join a DPC (direct primary care) practice and get preventive care and routine medical treatment for at as little as $50/month. They might buy catastrophes-only major medical insurance that ACA outlaws for persons over 30 years of age. Congress might enact Health Freedom Accounts as proposed by Rep. Chip Roy (R-Tex.) and liberalize Health Reimbursement Accounts.
Who would lose from overturning ACA? Insurers who collect the subsidies (the patients don’t) and the managed-care cartel that uses Medicaid as its cash cow. The politicians funded by those insurance interests. And likely the AMA.
States like California could create their own state-wide ACA—without forcing Americans in Texas and other states to pay for it. California projects a $21 billion surplus in its proposed budget, and the U.S. expects deficits without end.
For more information, see letter to President Trump, Mitch McConnell, and Kevin McCarthy.