# What will happen if the ACA is overturned? **URL:** \ **Category:** Great Debates\ **Created:** [March 22, 2021, 5:13pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444 "2021-03-22T17:13:05Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![DeadTreasSecretaries](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/deadtreassecretaries/32/4817_2.png) [@DeadTreasSecretaries](https://boards.straightdope.com/u/DeadTreasSecretaries)\ **Post date:** [March 24, 2021, 2:28am UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/21 "2021-03-24T02:28:19Z")
I think in the present moment, the tax would be backbreaking for a lot of people. We’re kind of lucky we don’t have it in the short term - with people in such dire financial straits over the lockdowns. GOP propaganda probably wouldn’t change, but a lot of people who couldn’t give a rats ass about the culture war nonsense are going to notice if a chunk of the stimulus check they just got gets scooped back up by Uncle Sam. Although in the long term I’m not entirely sure the ACA as presently constructed can last forever with no penalty. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [April 4, 2021, 1:30am UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/22 "2021-04-04T01:30:16Z")
> [@DeadTreasSecretaries](#): > > Although in the long term I’m not entirely sure the ACA as presently constructed can last forever with no penalty. I think for the ACA to truly get us to UHC, we’d need a penalty with real teeth (example: Switzerland). But without a penalty, I see the ACA continuing on like it is, giving millions access to health insurance, but without being able to get everyone in the game. I think there’s a certain % that won’t buy unless they’re made to buy. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [April 17, 2021, 6:14pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/23 "2021-04-17T18:14:20Z")
> [@survinga](#): > > I think for the ACA to truly get us to UHC, we’d need a penalty with real teeth (example: Switzerland). But without a penalty, I see the ACA continuing on like it is, giving millions access to health insurance, but without being able to get everyone in the game. I think there’s a certain % that won’t buy unless they’re made to buy. I agree, but anything that looks like a penalty and not a “tax” would run afoul of the fifth Roberts vote in the ACA case and make the entire scheme unconstitutional. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [April 17, 2021, 6:42pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/24 "2021-04-17T18:42:04Z")
> [@UltraVires](#): > > I agree, but anything that looks like a penalty and not a “tax” would run afoul of the fifth Roberts vote in the ACA case and make the entire scheme unconstitutional. And what if it is a “fee”? My thought on the best way to get universal coverage is to impose a fee on anyone who has not signed up for appropriate coverage, and use that fee to pay for signing them up for either a public option, or at the very least, a certified private insurer on the exchange. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [April 17, 2021, 6:45pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/25 "2021-04-17T18:45:59Z")
> [@k9bfriender](#): > > And what if it is a “fee”? > > My thought on the best way to get universal coverage is to impose a fee on anyone who has not signed up for appropriate coverage, and use that fee to pay for signing them up for either a public option, or at the very least, a certified private insurer on the exchange. That seems to me to be the forced purchase of a product which Roberts and the other four held to be a violation of the commerce clause. ---
**Author:** ![Bootb](https://avatars.discourse-cdn.com/v4/letter/b/e19b73/32.png) [@Bootb](https://boards.straightdope.com/u/Bootb)\ **Post date:** [April 18, 2021, 8:36pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/26 "2021-04-18T20:36:34Z")
> [@running\_coach](#): > > Question: Has the Supreme Court ever reversed a decision that was a major move “forward”? That depends on your definition of “forward.” I would image that some people at the time genuinely considered Plessy v. Ferguson to be rather progressive. ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [April 18, 2021, 8:39pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/27 "2021-04-18T20:39:27Z")
> [@Bootb](#): > > > [@running\_coach](#): > > > > Question: Has the Supreme Court ever reversed a decision that was a major move “forward”? > > **That depends on your definition of “forward.”** > > I would image that some people at the time genuinely considered Plessy v. Ferguson to be rather progressive. - Are you joking? ---
**Author:** ![Mallard](https://avatars.discourse-cdn.com/v4/letter/m/b9bd4f/32.png) [@Mallard](https://boards.straightdope.com/u/Mallard)\ **Post date:** [April 18, 2021, 9:11pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/28 "2021-04-18T21:11:23Z")
He’s being satirical but his example fits for the day, IMHO. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [April 19, 2021, 2:24am UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/29 "2021-04-19T02:24:40Z")
> [@running\_coach](#): > > Are you joking? When the likely alternative was public transport that was “whites-only”, yes, I can see it being seen as a progressive decision. In theory, it ensured that Black people could have access to public services. ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [April 19, 2021, 2:28am UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/30 "2021-04-19T02:28:45Z")
> [@Northern\_Piper](#): > > > [@running\_coach](#): > > > > Are you joking? > > When the likely alternative was public transport that was “whites-only”, yes, I can see it being seen as a progressive decision. In theory, it ensured that Black people could have access to public services. - But that wasn’t the question I asked. Yes, _Plessy_ was a step forward. _Brown_ was a further step forward. _Obergefell_ was a step forward. What I was asking is if SCOTUS has ever reversed such a decision. ---
**Author:** ![DeadTreasSecretaries](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/deadtreassecretaries/32/4817_2.png) [@DeadTreasSecretaries](https://boards.straightdope.com/u/DeadTreasSecretaries)\ **Post date:** [April 19, 2021, 2:14pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/31 "2021-04-19T14:14:36Z")
> [@k9bfriender](#): > > And what if it is a “fee”? > > My thought on the best way to get universal coverage is to impose a fee on anyone who has not signed up for appropriate coverage, and use that fee to pay for signing them up for either a public option, or at the very least, a certified private insurer on the exchange. This is similar to Biden’s plan - he essentially had a plan where a loss in coverage would automatically enroll someone in the public option. Personally I don’t think it’s necessary to risk that something like this would get struck down, and I definitely wouldn’t trust the court post-ACB to narrowly remove the exact thing they construe as mandatory healthcare without neutering the rest of the law in this scenario. Just having a public option available to everyone would dramatically improve the situation, possibly more than just adding a fee would. Public option + the old fee from the original ACA would likely be better. If we wanted to get to 99+% of people covered we would either have to do some sort of automatic enrollment or we’d have to just go to single-payer. We could potentially just make the fee for not having coverage equal to the cost of the public option. There might be some concern there that people might think they are forced to pay the fee and not get care for some reason. Obviously truly universal coverage is the ideal, and the most legally airtight way to make that happen is single-payer. If we’re not willing to do that, I’d rather see the safest way to get 95%+ covered that we’re extremely sure wouldn’t get struck down. The other thing we have going on now is that the American Rescue Plan subsidizes 100% of COBRA. There’s a chance this just becomes the new normal also. I don’t think that would eliminate the need for a public option but it may dramatically reduce the need for a penalty. ---
**Author:** ![BigT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigt/32/12044_2.png) [@BigT](https://boards.straightdope.com/u/BigT)\ **Post date:** [April 19, 2021, 2:36pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/32 "2021-04-19T14:36:14Z")
> [@RitterSport](#): > > It’s not clear to me, but anyway, they’ve already shot their load for reconciliation this year, so I think it would have to be next year, assuming they could get, for example, Joe Manchin, on board. There’s been a big change on that front. The Senate Parliamentarian has determined that it is possible to amend resolutions with the reconciliation process. So it is possible for the Democrats to amend the bill they’ve already passed. Here is Beau of the Fifth Column taking about it, arguing they’ll probably pass about half of Biden’s infrastructure bill that way. That said, this video was nearly 2 weeks ago, and I don’t know what’s gone on since then. [![](https://img.youtube.com/vi/i7_lZlc0hhs/maxresdefault.jpg "Let's talk about surprising Senate shenanigans and infrastructure....") ](https://www.youtube.com/watch?v=i7_lZlc0hhs) ---
**Author:** ![Hari\_Seldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hari_seldon/32/5173_2.png) [@Hari\_Seldon](https://boards.straightdope.com/u/Hari_Seldon)\ **Post date:** [April 20, 2021, 3:54pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/33 "2021-04-20T15:54:08Z")
Plessy was indeed a step forward. Separate **but equal** was positive. Unfortunately, the “equal” was never enforced, certainly not in the context of schools. In fact, there was some debate at the time of Brown whether they should have gone instead for equal. But to get back to the point raised, I assume the 1960s voting rights act was once upheld in the court and then that decision was reversed in 2013. Sure only one provision of the act was reversed but that was the heart of it. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [June 19, 2021, 7:48pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/34 "2021-06-19T19:48:44Z")
So, the ACA was not overturned. For the third time, SCOTUS refused to throw it away. > **['Obamacare' survives: Supreme Court dismisses big challenge](https://apnews.com/article/supreme-court-dismisses-obamacare-challenge-67cc2e9604a70b1b329c5f3b4177a688)** > > WASHINGTON (AP) — The Supreme Court, though increasingly conservative in makeup, rejected the latest major Republican-led effort to kill the national health care law known as “Obamacare” on Thursday, preserving insurance coverage for millions of... Amazingly, there are about 31 million who have health insurance via the ACA, either from expanded Medicaid or from private policies on the ACA State Exchanges. [https://www.healthaffairs.org/do/10.1377/hblog20210607.367870/full/](https://www.healthaffairs.org/do/10.1377/hblog20210607.367870/full/) This was a huge win. Biden now needs to do the things that will shore this act up and make it more like it was originally envisioned. The law is long overdue for an ACA 2.0 bill to shore it up. Make the recent changes from the Covid relief bill permanent, and plug some of the coverage holes. Also, there are 12 states left that still won’t expand Medicaid. Dems need to come up with something to help the 4 million people who are left out in those 12 states. > **[Biden makes it clear that #KillTheCliff & #UpTheSubs are the START of his...](https://acasignups.net/21/05/10/biden-makes-it-clear-killthecliff-upthesubs-are-start-his-healthcare-vision-not-end)** > > As expected, the healthcare section of President Biden's first address to a joint session of Congress (technically not a State of the Union, but close enough) included a call for making the subsidies expanded under the American Rescue Plan permanent... ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 19, 2021, 9:19pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/35 "2021-06-19T21:19:17Z")
Can Biden do anything to help improve ACA without legislative amendments? ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [June 19, 2021, 11:27pm UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/36 "2021-06-19T23:27:01Z")
He can do things around the edges to help. But congress will need to include an ACA 2.0 as part of a bill to really move the needle. Biden’s admin can do things like more advertising and outreach, paying more for navigators to help people get enrolled, rule against state waivers that try to make medicaid eligibility harder, and approve state waivers that do things like a public option. These help, but aren’t enough by themselves Legislation will be needed to make the stronger tax credits permanent, and to get rid of things like the “family glitch”. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 20, 2021, 2:38am UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/37 "2021-06-20T02:38:34Z")
What’s the “family glitch”? ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [June 20, 2021, 2:44am UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/38 "2021-06-20T02:44:17Z")
I’d not heard the term before (and I have a health insurance client), but [this site](https://www.healthinsurance.org/obamacare/no-family-left-behind-by-obamacare/) has a pretty good explanation: > [@](#): > > We still get calls on a regular basis from people who are shopping for individual insurance because adding dependents to their employer plan is prohibitively expensive. We estimate that roughly 20% of the people who contact us are [in this situation](https://www.healthinsurancecolorado.net/exchange-subsidy-eligibility-access-group-health/). > > Unfortunately, due to a “glitch” in the ACA, they are not eligible for [premium subsidies](https://www.healthinsurance.org/faqs/tag/premium-subsidies/) in the exchange if the amount the employee has to pay for _employee-only_ coverage on the group plan is deemed “affordable” – defined as less than [9.83%](https://www.irs.gov/pub/irs-drop/rp-20-36.pdf) of household income in 2021 (this [might end up being reduced to 8.5%](https://acatimes.com/aca-affordability-for-the-2021-tax-year) to keep pace with the other changes made by the [American Rescue Plan](https://www.healthinsurance.org/glossary/american-rescue-plan/), but the IRS has not issued guidance on this as of early April 2021). > > It doesn’t matter how much the employee would have to pay to purchase _family_ coverage. The family members are not eligible for exchange subsidies if the employee could get employer-sponsored coverage _just for him or herself_ , for less than 9.83% of the household’s income in 2021. As long as the employee’s portion of the premium is affordable, the cost for the family could end up being 25% — or more — of their household income and they’d still have no access to premium subsidies. They can either pay full price in the individual market, or pay whatever the employer requires to cover the family on the employer’s plan, despite both options being financially unrealistic. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 20, 2021, 2:46am UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/39 "2021-06-20T02:46:42Z")
Oh my. That makes my head hurt. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [June 20, 2021, 4:08am UTC](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444/40 "2021-06-20T04:08:24Z")
Thanks for Kenobi for doing the explanation on the family glitch. That’s something that an ACA 2.0 could easily fix. In addition to a basic ACA 2.0, there are other things in the works: 1. Getting around the 12 medicaid resistant states: There’s the medicaid gap in the 12 states that won’t expand medicaid. This has left millions of people who make too much to get medicaid and too little to qualify for the individual policy tax credits. These are strictly in red-states, where at this point the Republican opposition has been proven to be strictly partisan or ideological - not anything to do with the financial benefits of expanding medicaid to the state. The states that have expanded it have done quite well for their citizens, without bankrupting their state. Dems are now considering a bill which would actually bypass these 12 states, and go to counties or cities within their states, going local. It would be like a Medicaid expansion at the local level only. An interesting idea: > **[Analysis | The Health 202: Democrats devise a way to finally expand Medicaid...](https://www.washingtonpost.com/politics/2021/06/17/health-202-democrats-devise-way-finally-expand-medicaid-resistant-states/)** > > Rep. Lloyd Doggett's new bill would create a pathway for cities or counties to expand on their own. 1. Public Option: Also, there are 3 states where a public option is now on the table. Washington launched one last year (it needs more work to make it more attractive), and now Colorado and Nevada are getting into the game. > **[The public option is now a reality in 3 states](https://www.vox.com/policy-and-politics/22535267/public-option-health-insurance-nevada-colorado-washington)** > > We’re about to learn a lot about how a public health insurance option actually works in the US. [Previous page](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444.md?page=1) [Next page](https://boards.straightdope.com/t/what-will-happen-if-the-aca-is-overturned/938444.md?page=3)