Scalpel's Edge: As Supreme Court Weighs Obamacare, Healthcare Law Debated

As the nation's highest court heard oral arguments last week in the Trump administration-led lawsuit to dismantle the Affordable Care Act (ACA), proponents of the Obama-era health care reform law were spreading awareness about what repealing the act could mean for a country overwhelmed by the coronavirus pandemic.

Protect Our Care Arizona, a healthcare advocacy organization, held a virtual press conference on Tuesday, Nov. 10, to discuss what it means if the Supreme Court overturns the ACA, which the group says would put 2.8 million Arizonans with pre-existing conditions at risk of losing their healthcare coverage.

The ACA currently prevents health insurance companies from refusing coverage based on pre-existing conditions. If it were repealed, many of the unknown, long-term side effects of COVID-19 could be used by private insurance providers to deny care.

The argument against the ACA, made by the Republican Attorneys General of 18 states—including Arizona's Mark Brnovich, is that the entire act should be thrown out because its individual mandate that most U.S. citizens have health insurance is unconstitutional.

The healthcare bill has been upheld by the Supreme Court twice before, but now—a week after the presidential election—it's facing a majority of 6-3 Republican-appointed justices.

Will Humble, the executive director for the Arizona Public Health Association, said at the Protect Our Care press conference that he's worried about the ACA's fate, and pointed to the Supreme Court's minority opinion when the act went to trial in 2012 and four dissenting justices agreed it's illegal in its entirety.

"There are things that we need to think through and prepare for in advance so that if the court does end up striking down the Affordable Care Act, we're prepared as a community to have an alternative plan that handles many of the aspects, if not all the aspects that the Affordable Care Act took care of," Humble said. "A lot of that's going to depend on the nuances of what the court actually decides in the event that that the ACA is stricken in its entirety, which, by the way, I wouldn't be surprised to see."

Given the possibility the ACA could be overturned in a court with a majority of Republican-appointed justices, Humble believes there's a need for a solid replacement to the health care bill that has directed health insurance policy for 10 years.

"I think we have to operate under the assumption that there's a good chance that the Affordable Care Act is going to be stricken by this new court, and we've got to be prepared for some kind of plan B at the national level," Humble said. "I don't know exactly what that is, but hopefully a lot of people are thinking about that and documenting it so that there'd be some shovel ready work to be done in the event that it's necessary in 2021."

A viable replacement to the ACA would start at Congress, but Democratic Rep. Tom O'Halleran says it's difficult to create a backup plan without knowing any of the parameters in doing so.

"The next phase, we are thinking about it, we're trying to understand. But until we get the decision and the opinions that are written for that decision out, we're not going to know exactly what we have to plan for. So in other words, we have to plan for everything," O'Halleran said.

The U.S. Representative for Arizona's first congressional district says within his own experience in Congress, Republicans have failed to deliver an adequate health care replacement plan and said "there is no plan B right now for the Republican side of the aisle."

When it comes to the Democratic side, O'Halleran said, "We are trying to understand fully that we have to have something potentially up and going as quickly as possible in the house, and see if we can work with the Senate to get something through."

Though he didn't spare any details on what a new health care plan would entail, O'Halleran says he'd rather make changes to America's current health care bill instead of upending it all together.

"I would rather see us start to make the ACA more appropriately fit into the future health care of the American people," O'Halleran said "It's recognized that there are some deficiencies in it, but you don't throw it all out, you work with it. And the idea that it ever even had to come to the Supreme Court shows the dysfunction that we have to address within Congress on addressing an issue."

If the ACA is repealed, the nearly 130 million Americans with pre-existing conditions could face diminishing healthcare coverage, according to Protect Our Care.

When Arizona native Jeff Jeans was diagnosed with stage four cancer, he accredits the ACA for saving his life by allowing him to receive the treatment he couldn't afford on his own. Now, Jeans worries about the fate of other cancer survivors, as well as the new category of those facing coronavirus complications that could be considered pre-existing conditions.

"There are 392,000 cancer survivors in Arizona, and we all rely on the pre-existing condition protections that are given us in the Affordable Care Act," Jeans said. "And now we're getting a new demographic—COVID-19 survivors."

January Contreras, an Arizona attorney and former assistant director at AHCCCS—Arizona's Medicaid agency—says protecting the ACA is "just the right and legal thing to do," and has confidence in the attorneys "vigorously defending" the act at the Supreme Court.

Listening to oral arguments in the Supreme Court case against the ACA, Contreras says she felt "a little optimistic," especially given the fact Congress denied repealing Obamacare in 2017 when the former United States Senator John McCain cast his notorious thumb-down vote against overturning the law.

"We heard questions that do talk about, maybe they have concerns about one piece of this bill, which, of course, is the individual mandate. But does that really mean that in fact, the whole bill should be dismantled, when Congress didn't choose to dismantle it?" Contreras said. "Many experts who are not biased don't believe this litigation ever belonged in court, because Congress has had its say, and Congress did not vote to repeal the Affordable Care Act, they kept it in place with the exception of one provision."

Jeans agrees the decisions already made by Congress to keep the ACA should remain intact.

"[The ACA] impacts us all. I just hope that the Supreme Court can find it in their hearts to come to the same realizations that Joe Biden came to, that John McCain came to, that I came to in my hospital bed, and that they do the right thing and protect health care for all of us," he said.

As the fate of the ACA hangs in the balance, Contreras believes dismantling the ACA would cause unnecessary chaos during an unprecedented pandemic.

"There has to be some recognition of where we are as a country. That we are in the middle of a once in a lifetime pandemic, that our cases are surging, that the Affordable Care Act reaches into our lives in so many ways," Contreras said. "When it comes to this Supreme Court case, it's going to take five votes to cause all the havoc that could ensue, and I'm hopeful that that may not happen based on the questions we heard today. Cautiously hopeful, I will add."

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