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Majority conservative Supreme Court to rule on overturning Obamacare today - in move that could leave 20 million uninsured and let COVID-19 be classed as pre-existing condition to deny coverage

  When the majority conservative Supreme Court weighs the fate of Obamacare on Tuesday it will affect the way life is lived in the US for ju...

 When the majority conservative Supreme Court weighs the fate of Obamacare on Tuesday it will affect the way life is lived in the US for just about every American, especially the 20 million who be left uninsured if the law is repealed.  

Arguments will revolve around arcane points of law like severability - whether the justices can surgically snip out part of the law and leave the rest.

The argument against the Affordable Care Act (ACA) from the Trump administration and conservative states is that the 10-year-old statute was rendered unconstitutional in its entirety when Congress dialed down to zero a penalty on those remaining uninsured. 

The court has shifted solidly to the political right under President Donald Trump, with the newest addition of Amy Coney Barrett, and if opponents of the law prevail, what's at stake has real-world consequences, including allowing insurers to classify COVID-19 as a pre-existing condition to deny someone coverage. 

Before the ACA, insurers could turn a person down for an individual policy, or charge them more, based on their medical history. 

When the majority conservative Supreme Court weighs the fate of Obamacare on Tuesday it will affect the way life is lived in the US for just about every American. House Speaker Nancy Pelosi speaks during a news conference about protecting Obamacare

When the majority conservative Supreme Court weighs the fate of Obamacare on Tuesday it will affect the way life is lived in the US for just about every American. House Speaker Nancy Pelosi speaks during a news conference about protecting Obamacare 

The Supreme Court has shifted solidly to the political right under President Donald Trump, with the newest addition of Amy Coney Barrett (pictured), and if opponents of the law prevail, what's at stake has real-world consequences

The Supreme Court has shifted solidly to the political right under President Donald Trump, with the newest addition of Amy Coney Barrett (pictured), and if opponents of the law prevail, what's at stake has real-world consequences

Amy Coney Barrett questioned on repealing Affordable Care Act
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The nonpartisan Kaiser Family Foundation estimates that about 54 million working-age adults have health issues that would have made them 'uninsurable' before former President Barack Obama's signature law.

Tens of millions more have issues that could have led to higher premiums. Female gender was one, as insurers routinely charged women more.

COVID-19 would become America's newest pre-existing condition, for more than 10 million people who have tested positive so far.

Under the ACA, a coronavirus case cannot be used to deny someone coverage or charge them more. If Obamacare is gone, that becomes a real question.

Trump promised to always protect people with preexisting conditions, but never said how he'd do it.


In addition to COVID possibly being a new pre-existing condition, the ACA's two main programs for covering uninsured people would be wiped out if the law is overturned, leaving more than 20 million people uninsured unless a divided Congress can put a new safety net in place.

About 12 million low-income people are covered through the health law's Medicaid expansion, now available in most states. 

Most of them are adults working in jobs that don't pay all that much, and don't come with health insurance. 

Some have lost jobs in businesses like hotels, restaurants, and movie theaters, which continue to struggle because of the pandemic.

Another group, more than 11 million people, has private coverage purchased through taxpayer-subsidized private markets such as HealthCare.gov. This is also in jeopardy.

COVID-19 would become America's newest pre-existing condition, for more than 10 million people who have tested positive so far. Under the ACA, having the virus cannot be used to deny someone coverage or charge them more

COVID-19 would become America's newest pre-existing condition, for more than 10 million people who have tested positive so far. Under the ACA, having the virus cannot be used to deny someone coverage or charge them more

As it relates to preventive care, most American women now pay nothing out of their own pockets for birth control. That's covered as a preventive service, free of charge to the patient, under the ACA.

Many other services, from colonoscopies to flu shots, are also free. 

If people again face copays for routine preventive care, that may discourage some to go for tests shown to detect diseases like cancer at early stages when they are easier to treat.

Obamacare took the first major steps to close Medicare's unpopular 'doughnut hole,' a coverage gap that used to leave seniors on the hook for hundreds of dollars in prescriptions drug costs. Congress later accelerated the timetable.

Repealing the ACA would mean the return of the coverage gap, sure to infuriate older voters, many of whom say their medications still cost too much.

That's just one of many potential consequences to Medicare. The ACA slowed payments to hospitals and insurers to extend the life of the Medicare trust fund.

Meanwhile, one of the earliest benefits to take effect after the passage of Obamacare was a requirement that insurers allow young adults to stay on a parent's plan until they turned 26.

That provided a longer economic runway for millions of young adults, who back then were struggling with the lingering effects of the Great Recession. 

Nowadays it's the consequences of the coronavirus economy.

Before the ACA's coverage extension, insurers routinely cut off young adults upon graduation.

Obamacare raised taxes on upper income individuals to help finance its coverage expansion.

If the entire law is repealed, that would deliver a tax cut to well-to-do people, many of whom have escaped the economic shock of the COVID-19 pandemic because stock market investors have continued to do well.

Passing the 900-page-plus ACA was a political challenge that took more than a year at a time when Democrats controlled the White House and both chambers in Congress.

Putting together a replacement under a divided government would be the ultimate political puzzle. Neither Democrats nor Republicans agree even within their own ranks what that should look like.

President-elect Joe Biden (pictured Monday) would build on the ACA by improving it and adding a new public health insurance option

President-elect Joe Biden (pictured Monday) would build on the ACA by improving it and adding a new public health insurance option

Many Republicans, meanwhile, want to scale back the government's support for health care. They would make deep cuts to Medicaid financing. Protections for people with pre-existing conditions could be eroded under new rules. The Supreme Court is pictured on Thursday

Many Republicans, meanwhile, want to scale back the government's support for health care. They would make deep cuts to Medicaid financing. Protections for people with pre-existing conditions could be eroded under new rules. The Supreme Court is pictured on Thursday 

Biden: I don't question ACB's faith, but she'll gut Obamacare
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President-elect Joe Biden would build on the ACA by improving it and adding a new public health insurance option. 

But party liberals want a government-run system for all Americans, including the 160 million covered through employer plans.

Many Republicans, meanwhile, want to scale back the government's support for health care. 

They would make deep cuts to Medicaid financing, and leave the ACA's insurance markets as a state option. Protections for people with pre-existing conditions could be eroded under new rules.

Trump once famously said, 'nobody knew health care could be so complicated'. 

He made that statement in 2017, when he and a Republican-controlled Congress harbored hopes they could 'repeal and replace' the ACA.

It didn't happen then because Republicans could never agree on what a replacement would look like.

Fast forward to 2020. Health care has only gotten more complicated, in part due to the coronavirus. 

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