The Affordable Care Act was signed into law four years ago now. A great deal of time, manpower, and money has been invested in the infrastructure that the law creates, and data shows that the law is working. That is, people are signing up and people are getting care–care that they otherwise would not be getting. About 8 million people signed up during the first open enrollment period, and the data is showing that many of those who signed up were people who did not have health insurance to begin with. In fact, a recent Gallup poll showed that the total uninsured rate in the U.S. has dropped to 13.4%, from 17.1% in the fourth quarter of 2013.
But that little four-point drop does not really illustrate the impact that the ACA is having on some individual communities. You can see the difference particularly in the African American and Hispanic communities, where rates of uninsured people are significantly higher than they are among white populations.
After the ACA was implemented, the drop in uninsured across black and Hispanic communities was nearly twice that of white enrollees. This information in and of itself is interesting, but it also highlights the very motivation behind the law, and shows that the law is actually working. In the populations that had the highest uninsured numbers, the decline in uninsured people has been the greatest. The law was designed to help people who had otherwise been shut out of the health insurance market get covered.
You can see similar numbers when looking at enrollment rates according to income levels. The decline in uninsured people was only slight among households making more than $90,000 annually, but it was quite dramatic among those making less than $36,000.
The people who are living on the margins are the very people who were most likely to be positively affected by the ACA, and they are also the most likely to be affected by a new D.C. Circuit federal appeals court decision. In Halbig vs. Burwell the appellate court decided that the federal subsidies, which help about 4.7 million people buy health insurance, cannot be granted in the 36 states that refused to set up their own exchanges. In those states, the federal government provided an exchange where people can purchase health insurance.
Now the court's decision in Halbig threatens anyone who depends on the federal subsidies to be able to afford health insurance. It is a serious blow to the ACA, which is an imperfect law, but an important one, particularly for the black and Hispanic populations, as well as for people who live in or on the cusp of poverty.
Nelson Mandela famously said that "A nation should not be judged by how it treats its highest citizens, but its lowest ones." The Affordable Care Act has been controversial and contentious since it was introduced as legislation, but it had behind it a force that was good: Protect the most vulnerable among us. But if this court decision stands, it is not entirely clear that we will be able to trust Congress to actually make an effort to fix the law.
This decision is not the end of the line: It is likely that this case will end up before the Supreme Court. But in the mean time, people (and states) who depend on federal subsidies will be stuck in a land of limbo wondering once again if they will be pushed out of the health insurance market.
Image: Flickr photo by United Workers.
