I had just shared a new prostate cancer diagnosis with my patient.  He smiled.  Smiled!  “I just signed up for health insurance doc, my kids helped me through the website.” Despite the uncertainty held in his medical diagnosis, he felt fortunate to be an early enrollee in a Patient Protection and Affordable Care Act (ACA) compliant insurance policy via Washington Health Plan Finder, with a chance to dramatically limit his disease-related financial burdens. 

With a Supreme Court ruling on the ACA pending for November 10, it seems like a good time to reflect on the law’s impact this past decade.  The combination of expanding Medicaid coverage in our state to those making up to 138% of the poverty level and tax credits for those making up to 400% has led to an additional 600,000 Washingtonians with healthcare coverage[i].  When the new HCA.gov site went live in October 2013, it was overwhelmed with 8 million visitors in the first few days.  Many felt that the website’s operational inefficiencies reflected a government failure, while others acknowledged the impressive demand for this new supply of healthcare coverage.  Nationally, this program has insured an additional 20 million Americans and brought the uninsured rate to below 10% for the first time ever, while reducing uncompensated hospital care by 47%[ii].  Despite widespread concerns of financial repercussions for physicians, average physician salaries have continued to show increases until today’s current pandemic-influenced uncertainty[iii]. 

While uninsured rates declined for all ethnicities, racial minorities with histories of greater uninsured rates showed larger decreases in these rates, most notably with a decline in the national Latinx uninsured rate from 33% in 2010 to 22% in 2018[iv], making the ACA an effective piece of antiracist legislation.  Historic rates of unemployment have highlighted the importance of affordable insurance options outside of traditional employer-based models.  Keeping kids covered under their parents’ plans during equally historic youth unemployment remains important as well.  65million Americans have pre-existing conditions and remain eligible for health care coverage under the ACA and it is unclear how many more could potentially be discriminated against without the ACA, given the increasing identification of post-COVID-19 “long haulers”[v] with ongoing organ dysfunction and chronic symptoms.

The biggest criticisms of the ACA are likely that it is not transformational enough.  Bronze plan subscribers experience cost-sharing at 40% for non-preventative services, along with high deductibles and narrow networks that also reflect broader shifts in the insurance industry as a whole.  These concerns do not take away from the fact that coverage is overall increased and must include 10 categories of Essential Health Benefits including pregnancy, maternity, and newborn care and mental health and substance use disorder services among others provides free preventative services and serves as a catastrophic coverage backstop.  For those that would like to see more done, that is an important conversation to be had.   Attacks from a purely fiscal conservative viewpoint at this time seem more ideological than helpful in the midst of the pandemic.  The costs of further destabilizing the health care market and then implementing an alternative to this far-reaching bill would be inopportune, not offering an alternative seems worse yet.  I participated as a panelist in the Inland Washington State of Reform conference last month and had the chance to hear from many state health policymakers on the matter.  There is a very palpable concern that Washingtonians will suffer if federal ACA funds are removed from our state’s 2021 healthcare budget.

Dr. Wendy Wong is a board-certified emergency medicine specialist at Virginia Mason in Seattle. She attended Tulane University School of Medicine and completed her residency at Alpert Medical School of Brown University. 

Dr. Jessica Ivers is a board-certified pediatrician at the Polyclinic in Seattle. She received her medical degree at the University of North Dakota School of Medicine and Health Sciences, and completed her residency at Seattle Children’s Hospital.