By The Herald Editorial Board
Thursday’s U.S. Supreme Court decision, with a 7-2 majority upholding the Affordable Care Act, wasn’t a huge surprise; at least two of the court’s six conservatives — including Chief Justice John Roberts, the decisive swing vote in the ACA’s first challenge before the court in 2012 — telegraphed their likely positions during oral arguments in November.
With the ACA challenged for a third — and likely, final — time by Republican state attorneys general, the court last week reversed a lower court decision that the ACA, also known as Obamacare, was unconstitutional. The challenge lost on procedural grounds; the states had no legal standing to challenge the law, the majority said. Still the high court’s message to Republican opponents of the ACA, particularly those in Congress, should be clear after three court reviews in less than a decade: If you want to be rid of Obamacare, you’re going to have to do it yourselves.
But opponents in Congress now would have to argue against the ACA’s successes.
The ACA has provided health care coverage to some 20 million more Americans, reducing the number of uninsured from 46.5 million in 2010 to 26.7 million in 2016, according to the Kaiser Family Foundation. The number of uninsured ticked up to 28.9 million in 2019 during the Trump administration; thanks to his and fellow Republicans’ efforts to undermine Obamacare when they couldn’t repeal it. But there’s hope that, particularly after federal pandemic relief packages increased subsidies to purchase insurance on the ACA’s exchanges, the percentage of uninsured Americans will resume a downward trend.
Likewise, the ACA has maintained its public support in recent years. In April 2017, again according to the Kaiser Family Foundation, equal percentages of Americans — 46 percent — viewed Obamacare favorably and unfavorably. Since then support for the ACA has stayed steadily above 50 percent; most recently, 53 percent viewed the ACA favorably, while only 35 percent were unfavorable, a reversal in public opinion from its early years.
But even in preserving Obamacare, the Supreme Court also hasn’t settled the issues of health care coverage and its costs. While successful, both in terms of reducing the number of uninsured Americans and in the percentages of Americans supporting it and its popular provisions, the act still has fallen short of providing a universal level of health care coverage and in more effectively reducing the costs of health care.
Among legislative proposals to expand coverage are plans to reduce the eligibility age for Medicare from 65 to 60, make permanent the pandemic relief aid’s ACA market subsidies that are now scheduled to end in 2022, enact the long-standing demand to allow Medicare to negotiate drug prices with pharmaceutical companies, and, of course, the proposal by Sen. Bernie Sanders, I-Vt., Rep. Pramila Jayapal, D-Wash., and others to move to Medicare For All, opening the system to all Americans.
And then there’s the public option.
Where Medicare for All or other single-payer health care proposals would end the need for private insurance, the public option would add government-sponsored insurance as an alternative to employer-subsidized private insurance.
Supported by then-candidate Joe Biden during the presidential campaign, a public option would provide a federally sponsored alternative to private insurance with coverage obtained through the ACA’s insurance marketplaces. Biden’s plan, for example, would be free to those with an income below 138 percent of the federal poverty level and premiums would be capped at 8.5 percent of income.
Prior to the court’s ACA decision, Sen. Patty Murray, D-Wash., chairwoman of the Senate Health, Education, Labor and Pensions Committee, announced plans by herself and her counterpart in the House, Rep. Frank Pallone, D-N.J., to begin work drafting legislation for a public option.
“A federal public option will help guarantee that no matter where you live, who you are, or what your income, if you live in America, you can get the quality health care you need without worrying about cost,” Murray said last month.
In announcing the proposal, Murray called for comment and information from the public, consumer groups, health care organizations and providers and others as work begins to craft the legislation’s provisions.
“We are asking people to give their thoughts and feedback,” as her committee looks at different proposals, Murray said last week in a phone interview.
Supporters of a public option system say it would offer lower premiums and payments to those enrolled, would allow the government insurance plans to negotiate lower costs with providers and drug companies and would increase competition, potentially driving down costs for those with private insurance plans.
And it, even more so than the ACA, has strong public support.
A recent poll by Morning Consult/Politico found that 68 percent of voters support a public option plan, with only 18 percent opposed. While 8 in 10 Democrats supported a public option, a strong majority of Republicans — 56 percent — backed such a plan, with only 32 percent opposed. A public option also had stronger support than did Medicare For All, which had 55 percent from voters overall, but only 28 support from Republicans.
The public option’s popular support, particularly among Republican voters, could help during consideration in a closely divided Congress.
And — Republican opposition to Obamacare notwithstanding — Congress is capable of bipartisan action on issues of health care.
Rep. Suzan DelBene, D-Wash., who represents the state’s 1st Congressional District and also is a supporter of a public option, noted last December’s agreement in Congress to end the practice of hitting patients with unexpected costs for out-of-network medical providers.
“We reached a bipartisan compromise to end surprise medical billing,” DelBene said last week. “That was an important resolution of an issue that had been a major problem.”
With the future of the ACA now secure from further court challenges — and in recognizing the work that remains to provide health care coverage and lower its costs — Congress has an opportunity to fully deliver on the ACA’s promises.
With our pandemic year — and then some — now beginning to recede, most Americans have a new appreciation for their health and those who work to protect it. Easy and affordable access to health care is a right. Allowing the option of a government-sponsored insurance plan can assure that right for all.