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What happens if the Affordable Care Act is eliminated during a pandemic?

The fate of the Affordable Care Act, often referred to as Obamacare, is on the line again. The Trump administration has filed a brief with the Supreme Court arguing the law, through which 23 million Americans get health insurance, is unconstitutional. Judy Woodruff talks to Andy Slavitt, former acting administrator of the Center for Medicare and Medicaid Services, about the law's sweeping reach.

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  • Judy Woodruff:

    The fate of the health care law often referred to as Obamacare will be on the line again as the COVID pandemic plays out.

    Last night, the Trump administration sought to strike it down, this time by filing a brief with the Supreme Court arguing that it's unconstitutional. Eighteen states joined in, contending that the law must be overturned because Congress eliminated the individual mandate.

    More than 23 million Americans get coverage through the ACA, but, for some, the costs of that coverage are still high.

    Andy Slavitt is the former acting administrator of the Centers for Medicare and Medicaid Services during the Obama administration. And he joins me now.

    Andy Slavitt, welcome back to the "NewsHour."

    As you know, the argument that the Trump administration and these 18 states are making is that, now that there's no longer a tax penalty imposed on people if they don't have insurance, that this law no longer has a constitutional basis, and, therefore, it should be overturned.

    Without getting too much into the legal weeds on this, Andy Slavitt, why is that wrong?

  • Andy Slavitt:

    Well, their suggestion is that, when the Senate passed a tax law in the end of 2017, that it actually intended not to just eliminate the mandate, but intended to eliminate the entire law, in other words, that one was intended to strike down all.

    Senator Lamar Alexander made very clear when he said, that was not the intent of anybody voting. Nobody was voting to repeal the entire law.

    So they are — I think this case is attempting to, and I think in a political fashion, try to reinterpret what congressional intent was, with really profound impact on the American public. This is such a far-reaching law now.

    It's not just the 23 million people who have coverage. It's the 130 million people who have preexisting protections, more people who will need coverage coming out of COVID-19 and preexisting condition protection. So it's a sweeping law change to make on that basis.

  • Judy Woodruff:

    So, they're making the argument that it's not constitutional.

    And as you know very well, there's also criticism, as we just said, that, for many Americans, the premiums are still too high. How do — what's the answer to that?

  • Andy Slavitt:

    Well, look, there is plenty to not like about our health care system, and no one law, whether it's the ACA or any other law, is going to fix it all.

    What we need to do is keep improving our health care system and make it more affordable for more people. There is a bill that was just introduced this week that attempts to address that. I think it's long overdue. I think, when the Republicans were controlling the Congress, rather than trying to tear it down, they could have put forward these improvement bills.

    What we need to do is make sure that everybody gets a proper tax treatment that employers get. And right now, if you earn up to about $100,000 a year, it's affordable to get health care, because you get the same tax subsidy employer gets.

    But if you're over at $100,000 a year, you don't. That's clearly a gap in the law, because there are plenty of people who make over $100,000 a year to whom health care is just way too expensive.

  • Judy Woodruff:

    So, Andy Slavitt, quickly, back to your first point, what does it mean in human terms if this law is overturned, if the court does find it unconstitutional, especially, as we said, now that we're in the middle of a pandemic?

  • Andy Slavitt:

    Well, it means a few things.

    First of all, directly, 23 million people will no longer be able to take care of their families if someone should get sick from COVID or anything else, preventive care and all the things that come along with it.

    Secondly, if you have employer-based coverage, it will now be up to the insurance companies to decide what to cover and what not to cover. And if you lose employer-based coverage, you won't be able to be guaranteed to get that coverage back, or, if you get it, your preexisting conditions will be excluded.

    No matter what is said by the White House rhetorically, that is just the fact. And what happens to all of that money that is being spent to get people health care? Well, the top 0.1 percent of earners are going to get a $200,000 tax cut.

    And I think what's behind a lot of this is that the people who are pushing to repeal the law would rather you have that money used for a tax benefit for the wealthy than for people individually.

    Of course, if you have COVID, and it becomes a preexisting condition, it's not just COVID. It's all the complications from COVID. Have a lung problem, have a blood clot, have any kind of immunological problem in the future, an insurance company would be able to decide not to cover it.

  • Judy Woodruff:

    Your point being the repercussions much greater, of course, while we're in the middle of fighting COVID-19.

    Very quickly, Andy Slavitt, the fact that, today, number of COVID cases surging around the country.

    You follow this very closely. The White House is saying this is not due to reopening. It's what the vice president, Vice President Pence, said today. How do you read the cause behind this resurgence across the — much of the country, 16 states?

  • Andy Slavitt:

    Well, this is what the virus does. The virus moves from bigger cities to smaller cities.

    And so, at some level, we seem to be one of the only nations in the world that doesn't understand that that's going to happen. And then there's cause and effect and a time lag. So, we — I think we have, particularly in Arizona and Texas and Florida, governors that have been repeatedly told through the course of May that this was going to happen.

    And they waited not only to see enough cases. They waited not only to see their positivity rate go up. They waited until their hospitals started to fill. At this point, if they acted today with strong action, they wouldn't be able to turn the tide around for another three weeks or so.

    So, we're really dealing with the middle of July. And, of course, things are going to continue to go on and continue to get worse. So, we have not — I think we have to get a better feel for what's causing these things. We have to be more honest.

    And the vice president, with all due respect, can't come out and paint a rosy picture. It's not fair to the public, who needs — who just wants to know, what do they need to do to be safe?

  • Judy Woodruff:

    Certainly bad numbers today in the terms of COVID recurring, resurging across much of the country.

    Andy Slavitt, we thank you.

  • Andy Slavitt:

    Thank you, Judy.

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