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During the COVID-19 Pandemic, the Affordable Care Act Is in Danger

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The hum of my oxygen mask barely muffled the medivac helicopter’s propellers as we flew to Arrowhead Medical Center in San Bernardino, California.

Fourteen years ago, a fun day snowboarding turned into a middle-of-the-night emergency. I was struggling to breathe. Friends rushed me to the small mountain clinic where medical professionals did what they could to stabilize me. My symptoms indicated fairly quickly that I needed to get to a lower altitude to restore my oxygen saturation levels and keep me alive.

I had severe high altitude pulmonary edema. Doctors spent the better part of four days making sure I could breathe on my own. A priest came to see me. Family and friends brought magazines. Soon I felt healthy enough to return home to San Diego to recover.

But nothing could prepare me for the onslaught of medical bills because I no longer had health insurance.

My flight down the mountain occurred four years before President Barack Obama signed the Affordable Care Act in 2010. The law has made significant strides to expand access to care through an insurance marketplace with subsidies for lower income families and individuals. It expanded access to Medicaid and mandated equal coverage for mental health services. This month the landmark law turns 10. Millions of Americans have gained health coverage and people with life-threatening conditions have access to essential care.

Ten years later, the law is more popular than ever. It turns out that many Americans like the fact that health plans cover essential benefits, that young people finding their place in the world can remain on their parent’s health plans until age 26, and that people can no longer be denied access to life-saving coverage because of a preexisting condition. The ACA also eliminated annual and lifetime caps on the amounts insurers would pay to cover the cost of care. States that expanded Medicaid under the law saw improved health outcomes. Still, Republicans remain relentless in their effort to eliminate the law while failing to put forth a credible alternative.

President Trump and his administration have taken an aggressive approach to erode the Affordable Care Act since he took office in 2016. Under Trump, states were allowed to add work requirements to Medicaid (though it faces legal challenges), insurance that covers lower income Americans. Government subsidies to insurance companies who offered public marketplace options were cut while short-term insurance plans with little benefit to patients were expanded. According to the Kaiser Family Foundation, the number of uninsured Americans decreased from about 46.5 million people in 2010 to nearly 27 million in 2016. However, the number of uninsured people in the U.S. has begun to creep back up since the Trump administration began sabotaging the Affordable Care Act.

The biggest threat yet is a state-led Republican effort effort to strike down the ACA’s individual mandate, which required every American to have health insurance or pay a penalty. It was designed to encourage more people to enroll in health insurance and ensure younger and healthier people were contributing to the collective health insurance pot to make care affordable for more people. In 2017, Congressional Republicans used Trump’s tax overhaul to essentially eliminate the individual mandate by reducing the penalty for not having insurance to $0.

In 2012, courts had ruled the individual mandate penalty was a tax and therefore constitutional. But in a series of new challenges since Trump has taken office, a Texas federal judge ruled the entire ACA should be thrown out because of the individual mandate, but a federal appeals court sent the decision back for more consideration in December 2019. On March 2, the Supreme Court announced it would intervene and hear the case. Though the court won’t rule on the ACA until after the November presidential elections, it could hear oral arguments sooner and still cause upheaval to health care protections.

With the Supreme Court’s decision to hear the Trump-backed lawsuit to repeal the Affordable Care Act, health coverage and access to care for millions of people is once again at risk. When I think about what’s at stake for Americans should this reckless Republican assault on our care prevail, I’m reminded of my own story and the scare that comes with insurance companies putting profits over the health of sick people.

Having graduated college, I no longer qualified as a full-time student under my parents’ insurance policy. Like many recent graduates, I needed to figure out the next step and find full-time work. At the time, I worked two part-time jobs and I interned for my state senator — excellent experience but none came with health coverage.

Staring these medical bills in the face frightened me. The average cost of a medivac flight ranges between $12,000 and $25,000 per transport. I wanted to focus my energy on navigating a career path and paying off my student loans, not on trying to forge a path through the maze that is the American health care system.

Private insurance denied my application because of a few preexisting conditions that deemed me to be high risk. Born two-months premature with under-developed lungs and scoliosis, the insurance company considered me too costly to cover. I reached out to the California Department of Health Services to inquire about coverage options for folks that do not qualify for the state’s Medicaid program.

The COVID-19 pandemic has shed harsh but important light on the American health system. Doctors, nurses and health care workers reporting to duty, around the clock, to help contain the spread of the virus and care for the infected. As more people get sick, we’re seeing firsthand why laws like the ACA  — that provide protections for 135 million people with preexisting conditions and health coverage for 20 million people — must be strengthened instead of repealed.

I am forever thankful I had help paying my medical bills. It enabled me to build a career in public service that eventually took me to Washington, D.C. But I know that many others are not as fortunate and sky-high medical bills often derail future plans, negatively affecting quality of life.

Today I live with pulmonary hypertension, a rare disease affecting the heart and lungs. Respiratory disease makes me high-risk to COVID-19 so I am practicing social distancing, taking all required precautions. I urge everyone to do the same. Current events call us to keep up the fight for true universal coverage. We must not only defend the gains we’ve made over the last 10 years, we have an obligation to build on them and protect our care. When it comes to guaranteeing access, quality and affordability of care, we cannot leave anyone behind.

Header image via hisa nishiya/Getty Images

Originally published: March 23, 2020
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