Iowa joins 19 states in brief defending ACA in U.S. Supreme Court case

Iowa Attorney General Tom Miller said Wednesday he hopes the COVID-19 pandemic will cause the Trump administration and others to reconsider their efforts to have the Affordable Care Act declared unconstitutional.

Iowa, 19 other states and the District of Columbia filed a brief Wednesday with the U.S. Supreme Court in the case of Texas vs. United States of America. The case grew out of congressional Republicans’ changes to the individual mandate of the ACA, the federal law sometimes referred to as Obamacare.

A judge in Texas ruled the entire law was rendered invalid by the changes to the mandate, but the United States Court of Appeals for the Fifth Circuit agreed only that the mandate was unconstitutional; it did not rule on the ACA itself, asking the lower court to reconsider the issue in more detail. Democrats intervened, and in March the Supreme Court agreed to hear their appeal of the ruling.

Although Iowa’s Republican governor, Kim Reynolds, has called the ACA “unsustainable, unworkable and  unaffordable,” Miller, a Democrat, has supported the law and is part of the 20-state coalition of Democrats who want the Supreme Court to uphold the ACA. He spoke during a news conference organized by a coalition of issue advocacy groups that support the ACA.

Miller said Wednesday that while the COVID-19 pandemic has caused millions of Americans to lose their jobs and look to the ACA for health coverage, it’s not likely to change the way the case is argued before the Supreme Court.

“But, you know, it’s something that would be obvious and known to the court,” he said. “They’re human beings, too. So, I think that is something they would consider in some way — even though it doesn’t affect the direct arguments. One thing that it does affect is what the other states and the administration does. You know, the best possible outcome now would be for the states — Texas and the others, along with the administration — to withdraw the lawsuit and allow the Affordable Care Act to go ahead in light of the current epidemic and circumstances.”

Miller said he has not talked to Reynolds about the possibility of her supporting the ACA in light of the number of Iowans who have lost their jobs and health coverage.

Last year, Miller and Reynolds came to an agreement that prevents Miller from signing Iowa onto any multi-state lawsuits without the governor’s permission. The ACA case is unaffected by that agreement since it was initiated before the agreement was reached.

Earlier this week, CNN reported that U.S. Attorney General William Barr tried to persuade the Trump administration to at least soften its opposition to the ACA, citing the potential for millions of newly unemployed Americans to lose coverage at the moment they most need it.

Miller said that if the Trump administration succeeds in having the court strike down the ACA, it would be a “catastrophe” for the people of Iowa.

“Twelve million Americans would lose their health care insurance through Medicaid expansion,” he said. “Nine million individuals would lose their health care through the individual marketplaces or exchanges. And most Americans would again be subject to the pre-existing condition exclusion for coverage, and that exclusion, over time, was like a cancer eating away at the health care system … If they are successful, the pre-existing exclusion would come back with a vengeance.

“What is at stake here is just enormous — and what a time for this to happen during this unbelievable COVID-19 pandemic. For people’s health care to be put in jeopardy at this time — it’s as bad a time as you can imagine, in my view.”

It’s not clear when the Supreme Court will hear the case, but arguments could be held this fall with a decision following sometime in 2021, long after this year’s presidential election.

For now, the ACA remains almost entirely intact, including the requirement that insurance plans cover vaccinations at no cost — a provision that is likely to matter to many Americans concerned about the spread of COVID-19 and a hoped-for vaccine.

Earlier this year, a poll by the Kaiser Family Foundation indicated that 55% of Americans support the ACA, and that repealing the act was, for the first time since 2016, no longer the top health care issue among Republican voters.

Before the COVID-19 pandemic struck, more than 11.4 million people were signed up for the ACA, and more than 12 million Americans were enrolled in the ACA’s expanded Medicaid program.