A high percentage of United States residents continue to rely on employer-based health insurance plans. The covid-19 crisis has unmasked the boom-or-bust nature of this approach. We asked the author of a Perspective published in The New England Journal of Medicine to share expertise with our readers.
The United States Supreme Court announced that it will again hear oral arguments on the constitutionality of the Affordable Care Act (ACA, or "Obamacare") on November 10, one week after Election Day. The newest challenge to the ACA is led by a contingent of 18 Republican state attorneys-general and is supported by the Trump administration.
However, amid the covid-19 pandemic that has led to widespread layoffs (and possibly permanent job losses), the uniquely American system in which a high number of people get their health insurance through their employers now threatens to cut millions of people off from their insurance plans. In that context, it is important to recognize the new options created by the ACA for health insurance that are unrelated to employment. These include more generous Medicaid eligibility criteria in the 36 states that chose to expand their programs, extension of dependent coverage to 26 years of age, and insurance marketplaces supported by consumer protections and premium tax credits.
In a recent article in the New England Journal of Medicine, my colleague Benjamin Sommers and I quantified the ACA's effect on changes in health insurance coverage after job losses. We used national data from the Medical Expenditure Panel Survey. We compared the trajectories in coverage for nonelderly adults who lost their jobs before 2014—the year the law's Medicaid and marketplace provisions went into full effect—with the trajectories of those who lost their jobs after 2014. As expected, there were large drops in employer-sponsored insurance after job losses (more than 12 percent), whether a job loss occurred before or after 2014. However, after implementation of the ACA, there were large gains in Medicaid (8.9 percent) and marketplace coverage (2.6 percent) that fully offset the reduction in employer-sponsored insurance for people who left or lost their jobs. These results suggest that the ACA will play a critical role in alleviating coverage losses related to the covid-19 recession.
In the context of millions of Americans losing their jobs in a short period of time, and an ongoing pandemic, overturning the ACA would likely be devastating to patients, clinicians, hospitals, and state economies. The very virus that has brought about record unemployment levels is the same agent that makes health insurance—and the new options created under the ACA—more important than ever.