The Affordable Care Act and coverage for Massachusetts residents is at risk

Over 375,000 Massachusetts residents could lose their health coverage and the state stands to lose up to $2.4 billion in federal funds if the ACA is overturned by the Supreme Court.

Senator Cory Booker of New Jersey looks over at photos of Americans who have benefited from the Affordable Care Act, known as Obamacare, that were put on display on the dais by Democratic members during the Supreme Court confirmation hearing for Judge Amy Coney Barrett before the Senate Judiciary Committee on the first day of her hearing on Capitol Hill, Oct. 12.Pool/Getty

Dave was laid off from his hotel job in March due to the coronavirus pandemic, and he lost his health insurance too. A week later, he was rushed to the emergency room with a lung problem. With support from an enrollment assister, he was able to enroll in MassHealth coverage that was made possible because of the Affordable Care Act, better known as Obamacare. He is just one of the hundreds of thousands of Massachusetts residents given a lifeline by the ACA.

Yet, the multi-year effort to repeal the law is coming to a head at the worst possible time. Just days after the November election, the US Supreme Court will hear oral arguments in a case seeking to overturn the ACA. And Supreme Court nominee Amy Coney Barrett has a clear record on the issue. She has openly questioned the constitutionality of the ACA, arguing that the Supreme Court’s ruling upholding the ACA’s individual mandate was “illegitimate.” If she is confirmed to the court, she may provide the decisive vote to strike it down. For people like Dave, and more than 23 million others nationwide, access to health care hangs in the balance.

The need for health care coverage has never been more dire than during the COVID-19 pandemic. It has laid bare devastating racial disparities in health care access and outcomes. The ACA coverage expansions led to progress toward equity, with the gap between the insurance coverage rate for Black and white adults dropping by 4 percentage points and the difference between Hispanic and white adults falling by 9.4 points. Instead of building on these important steps, overturning the ACA would further exacerbate inequities in access to health care.

The elimination of the ACA would also be devastating for people with specific health care needs, including 1.8 million people living with substance use disorders and mental illness. Protections would also be stripped away from 135 million people who have preexisting conditions like diabetes, cancer, asthma, and now those who have had COVID-19. Insurance companies could once again charge women 50 percent more than men for coverage and impose lifetime caps on benefits. It would strip a popular feature for families: coverage for those up to age 26 who have sought coverage on their parents’ plan at a time when youth unemployment has doubled due to the COVID-19 pandemic.

In Massachusetts, where our state’s health reform law served as a model for the ACA, many falsely believe that we would be protected if the ACA were struck down. This is not the case. Thanks to the ACA, a number of new protections were implemented in the Commonwealth: the provision allowing young people to stay on their parents' plan and the reduction of prescription drug costs for seniors caught in the Medicare “donut hole.” These protections could be gone overnight if the ACA were invalidated.

In addition, an ACA repeal would impact access to health coverage and care for hundreds of thousands of Massachusetts consumers. The state’s health insurance coverage expansions were only possible with the partnership and funding from the federal government. This is especially true for the expansion of MassHealth, our Medicaid program, as well as the availability of affordable coverage through ConnectorCare. Over 375,000 Massachusetts residents could lose their health coverage and the state stands to lose up to $2.4 billion in federal funds. These immense cuts would create a funding gap that would be impossible to fill even during normal times. The challenge is even greater now: According to some estimates, Massachusetts may face a deficit of up to $6 billion as a result of the pandemic. These funding shortfalls could have devastating implications for the health care safety net in Massachusetts.

Taking coverage away from people during the worst pandemic we have experienced in the last century is simply despicable, and we all should be outraged. Massachusetts deserves more from its president and its government. All of us must speak up, speak out, and make it abundantly clear that the ACA cannot be repealed.

Elizabeth Warren is the senior US senator from Massachusetts. Amy Rosenthal is executive director of Health Care for All. Kate Walsh is president and CEO of Boston Medical Center.