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Ending Obamacare Won't End Health Care Coverage

The U.S. Supreme Court has decided it will hear a state-led Republican challenge to the Affordable Care Act. At issue is the mandate to have health insurance and the viability of the law. 

In a 5-4 decision in June 2012—with Chief Justice John Roberts voting with the Court’s liberals, as he often does these days—the Court ruled that the law depended on the mandate to work. 

But Congress effectively eliminated the mandate in the 2017 tax reform law. The Republican plaintiffs argue that without the mandate the law can’t work and so cannot stand. 

Our best guess is that the Court’s liberals will vote in lockstep and that Roberts will once again provide them with the fifth vote. 

But even if Obamacare is overturned, it won’t have that big of an impact on the uninsured, especially during the pandemic. 

The Court won’t hear the case until October or later. And it probably won’t render a decision until 2021, likely in May or June, when the country hopefully should be past the coronavirus peak. 

In addition, the court could postpone the actual demise of the ACA for a year or so to minimize insurance disruptions and give Congress time to pass a replacement. 

Nor would a ruling against Obamacare greatly increase the number of uninsured. Roughly 85 percent of the country receives health coverage through an employer, Medicare or Medicaid. While the ACA enhanced all three coverages—at a cost in higher premiums and taxpayer dollars—it didn’t fundamentally change them. 

None of those options were ever allowed to deny coverage because of a preexisting condition—though employers might postpone coverage for a few months—nor could insurers drop covered people if they became sick. 

The ones most likely to be affected by ACA repeal are the roughly 19 million individuals who buy their own coverage, mostly through an Obamacare exchange. However, there were nearly that many people in the individual market before the ACA became law. 

Millions of people did obtain coverage through the exchanges, but millions also lost their individual coverage—including my wife—because of the ACA’s mandates and exploding costs. 

The biggest question mark is what happens to the ACA’s Medicaid expansion, which 37 states (including DC) have implemented. That is where nearly all of the increased health coverage came from. 

But even if the Court ruled against the ACA, it might not strike down all of its provisions, possibly leaving in the Medicaid expansion and other provisions in place. 

For their part, Republicans should ease the public’s fears by rallying around a replacement plan that increases coverage options and lowers costs—what Obamacare promised but failed to deliver.