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BERNARD COLUMN: Politics of health insurance

By Jack Bernard
Bernard is a retired corporate executive

On 02/26/18, Georgia AG Chris Carr and officials of 19 other Republican controlled states filed a suit to do away with the Affordable Care Act, citing questionable constitutional grounds. California v. Texas ultimately ended up at the Supreme Court, was decided on 6-17-21 and the ACA remains intact for now.

The suit was strongly supported by the Trump administration, which is consistent with the former President’s frequent declarations that he would repeal the ACA and replace it with something better. (Note: In his 4 years in office, Trump never came up with any reform proposal to accomplish this aim). The Biden administration opposed the suit in 2021.

The red states filing (i.e., “state plaintiffs”) included Georgia, Florida, Texas, Wisconsin, Alabama, Arkansas, Arizona, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Utah, and West Virginia. Wisconsin and Maine withdrew in 2019 after Democrats took state offices, leaving 18 states as plaintiffs. 

Many legal scholars heavily criticized the filing as political rather than legal in nature. There were 27 states who either defended the ACA, joined in defending on appeal or filed briefs supporting the ACA.

California v. Texas was recently decided in a 7-2 decision, with several conservatives joining the liberals. Essentially, the Supreme Court found that these 18 red states had no legal standing to sue. Thus, the ACA survived, and tens of millions of Americans kept their insurance.

But why did they sue in the first place? There are 14 states which have over 12% uninsured. The majority of them are among these 18 states suing to find the ACA unconstitutional. Three have the largest number of uninsured in the nation, including Texas, Florida and Georgia. Georgia has an uninsured rate of nearly 14% and still has 1.4 million uninsured residents, even after the ACA. Georgia could have expanded Medicaid under the ACA, as 38 other states have done, but chose not to do so. 

When the ACA was passed in 2010, millions of uninsured individuals obtained insurance. By 2016, over 20 million had been added. However, under Trump the number of insured fell as the number of uninsured went from 26.7 million to 28.9 million as the rate of uninsured climbed up.

Surveys have shown that America is the world’s most religious democracy. Therefore, as patriotic Americans, we should all look forward to the day when partisan politics is not as important as assuring that needy Americans have the healthcare that they need and deserve.