Court of Repeal: How the Supreme Court Might Impact Hopkins Healthcare

By Richard Pedersen

The Supreme Court is currently hearing arguments regarding the constitutionality of the Affordable Care Act (ACA), commonly referred to as Obamacare. Their ruling could have a significant impact on the health coverage of SAIS students, as well as much of the broader American public.

State attorneys general, led by Texas Attorney General Ken Paxton, have challenged the ACA’s mandate requiring all Americans to obtain health insurance coverage or else face financial penalties. Despite a 2017 law reducing that financial penalty to $0, these attorneys general assert that this individual mandate violates liberties protected by the Constitution. Moreover, they claim, the unconstitutionality of the individual mandate nullifies the rest of the law.

Any Court decision to overturn the entirety of the Affordable Care Act would have sweeping effects on American health insurance broadly as well as SAIS students in particular. New estimates from the Urban Institute project that a full repeal of the ACA would produce a nearly 70% increase in the uninsured population, representing roughly 21.1 million Americans. The law also introduced popular measures such as protections for pre-existing conditions, requirements for degrees of coverage, and the establishment of online insurance marketplaces.

For SAIS students, in particular, the ACA provides more options and coverage for students to obtain health insurance, such as allowing those under the age of 26 to stay on their parents’ health insurance plans.

Any repeal of the ACA would reduce coverage and coverage options on the private insurance market, shifting the costs of healthcare to the less healthy. While most students receive healthcare through the student health insurance option and would therefore be insulated from many of these changes, according to the Office of Student Life roughly 40% of the student body are currently enrolled in non-Hopkins provided insurance programs.

After the first week of Supreme Court hearings, however, two key Justices have indicated that they are unlikely to support a full repeal of the ACA. Chief Justice Roberts, often the deciding vote in contentious Supreme Court rulings, indicated that striking down the individual mandate would not nullify the entire law.

Justice Kavanaugh signaled a similar perspective, stating “It does seem fairly clear that the proper remedy would be to sever the mandate provision and leave the rest of the act in place — the provisions regarding pre-existing conditions and the rest.”

Experts project that any Court decision to strike down just the individual mandate would have little effect on the current insurance market. The mandate currently has little effect on enrollment given its $0 non-compliance fee.

Moreover, the 2017 reduction of that non-compliance fee to $0 had little effect on enrollment as well. According to Evan Saltzman, a health economist at Emory University speaking with the New York Times, “The evidence indicates that the marketplaces are doing about the same as they were before the mandate was set to zero.”

The details of the Supreme Court’s ruling on this case will therefore determine what, if any, impact on SAIS students. That ruling is expected to come by June.

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