As Court debates ACA future, Wisconsin advocates reiterate why it’s needed

As arguments wound up Tuesday morning in the U.S. Supreme Court on a lawsuit that could wipe out the Affordable Care Act, Gov. Tony Evers called on the justices to uphold the healthcare law and on lawmakers to take action if necessary to preserve the protections that it provides.

“In the middle of a global pandemic, what we need is more access to quality, affordable health care, not less,” Evers said during an online news conference sponsored by the ACA advocacy group Protect Our Care. The group has been mobilizing support for the organization and opposition to the lawsuit being argued before the Court.

Although Wisconsin once sided with the states led by Texas that are seeking to throw out the law, Evers said he was proud that, after his election and that of Attorney General Josh Kaul, the two were ultimately able to pull out of it and side instead with California and other states seeking to preserve the ACA.

More than 2.4 million Wisconsin residents — including himself — have preexisting health conditions and need the guarantee that the ACA provides that they won’t be denied coverage as a result, Evers said — “especially those who have survived COVID-19 and are suffering longer-term health consequences.”

The Rev. Dana Kelley of Milwaukee is one of those people.

Diagnosed with rheumatoid arthritis when she was 11 months old, Kelley went on to develop asthma and allergies. A year ago she was hospitalized for five days with a pulmonary embolism. And earlier this year, she was diagnosed with the coronavirus. While Medicaid has covered her health care, the ACA has ensured she can’t be denied coverage, or face astronomical premium costs, for any of those preexisting conditions.

“COVID has revealed a lot of medical issues and issues in the healthcare system that affects people of color at a higher rate than it does any other group or community,” said Kelley, who also took part in the call. 

“The Affordable Care Act can allow for people like me with preexisting conditions — whether they’re employed or unemployed, Black, white or Latino, rich or poor, heterosexual or LBGTQ+,” to get coverage, she added. “Wherever you are, whoever you are, we all need to be able to afford quality healthcare.”

In addition to the ACA’s protection for people with preexisting conditions, the healthcare law also eliminated lifetime caps on coverage. That is critically necessary, said another call participant, Dustin Klein, a Milwaukee man in his early 30s who has hemophilia.

Every 10 days, Klein must undergo prophylactic treatment that replaces a missing clotting protein that is the source of his condition. The treatment costs $15,000 to $18,000 a visit, Klein said, and the caps that were imposed on insurance coverage before the ACA would have soon locked him out of continued treatment.

For people with untreated hemophilia, one outcome can be for blood to pool in the patient’s joints.

“It’s going to deteriorate your joint completely, to the point where I know men who have had knee replacements at the age of 35, because of lack of access to quality healthcare,” Klein said. “I have happily been able to avoid that because of my determination and making sure that I’ve always had care. But I have never known a period of time where I didn’t have to struggle to keep my healthcare.”

Dr. Mike Miller, a Wisconsin psychiatrist and addiction treatment specialist on the call, said the ACA’s impact has been far more wide-ranging than just those protections.

“It’s not just a bill to increase health care access for insurance, which it does, but actually changes health care quality, and does a lot of things for prevention,” Miller said.

“Every bit of this will need to be hastily reconstructed legislatively if the Supreme Court finds some legal reasons to toss the whole ACA,” he added — requiring action in Congress and lawmakers “willing and able to do that.”

The ACA doubled funding for federally sponsored health centers, which would lose those additional funds if the law was thrown out, he said. It set standards that required insurance plans to cover 10 so-called essential benefits, including wellness screenings, preventive care, mental health and addiction care, maternal health care, and an annual wellness check for people who are enrolled in Medicare, “just like a well-baby visit in pediatrics,” Miller said. “It’s a wonderful enhancement that would go away if the bill were thrown out.”

In requiring coverage for mental health and addiction treatment, the ACA strengthened an earlier law that stated insurers could not impose tighter restrictions on those services than on medical and surgical coverage — but left insurers the option of whether to provide mental health coverage at all.

“Treating addiction is a really important way to actually reduce medical health care costs,” Miller said. “For every dollar spent on addiction treatment, you get $5-$7 back” in savings from medical and surgical costs that can arise as a result of addiction.

“The ACA was really important. It’s been successful. The public is in favor of it now,” Miller said. “There was so much disinformation when it was being debated, people were against it, because they thought it contained things when it didn’t.”

Since its passage and implementation, that’s changed. But Miller lamented political polarization over the law that has not only threatened its existence but blocked it from being made better.

“Once people got the coverage, people liked the coverage — and it’s a very popular act of Health Policy that should not be rejected,” Miller said. “It certainly can be improved. Our political climate has not allowed for any tweaking or improvements; it’s only been the Republicans saying ‘repeal,’ and the Democrats saying ‘preserve.’ We should be practical and come together and look at ways to improve it.”