Enrollment is down and the Affordable Care Act’s legality is being challenged. Here’s how it could affect you.

Share on Pinterest
Enrollment in Obamacare health insurance plans decreased to about 8.5 million during the initial registration period. Getty Images

Enrollment has declined slightly in Affordable Care Act health insurance plans.

The program, also known as Obamacare, is also under legal attack in a case that now appears headed to the U.S. Supreme Court.

If you receive health insurance through your employer or some other program, why should you care what happens to the Affordable Care Act?

Beyond the problems it might create for your fellow citizens, there could be ripple effects that eventually reach your premium payments or the quality of care you receive.

Here’s a look at the current challenges facing Obamacare and how they could affect you.

According to numbers released shortly after the federal enrollment deadline of December 15, about 8.5 million people have selected 2019 plans through the ACA website.

Nearly 6.5 million people had renewals while more than 2 million signed up for new policies.

The initial enrollment figures were about 400,000 less than the number of people who signed up through the ACA website for the 2018 program.

Those numbers aren’t final. There are still state-run programs that have deadlines lasting until late January.

There’s also the policies that are automatically renewed for people who had ACA plans last year and didn’t opt out for this year.

When it was all said and done last year, 11.8 million people had enrolled in 2018 ACA health plans. That was slightly less than the 12.2 million in 2017.

These figures also don’t include the 12 million people who have health insurance under the expanded state Medicaid programs allowed by the ACA law.

Every year since it passed, President Barack Obama has made a video to encourage people to sign up under the federal healthcare exchange.

The former president continues to push for people to enroll in the healthcare program that carries his name.

This year, his message was straightforward: Sign up to get health insurance for as little as $50 to $100 a month.

“That’s probably less than your cell phone bill,” Obama said.

President Donald Trump and other Republicans leaders have tried to undo the Affordable Care Act (ACA), at times calling it a failure.

“Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate,” Trump tweeted in July 2017. “Dems will join in!”

In 2013, the year before major coverage provisions of the ACA went into effect, more than 44 million non-elderly Americans didn’t have health insurance.

That decreased to just below 27 million in 2016.

That number, however, increased by about 700,000 people during the Trump administration’s first year in 2017, according to the Kaiser Family Foundation.

A healthcare system works much like the basic ideas of vaccination: You need to have enough people participate in order for it to have a healthy effect.

Kurt Mosley, vice president of strategic alliances for Merritt Hawkins health consultants, says there needs to be about 30 million people in the entire ACA pool.

That includes younger, healthier people who pay into the system and use it less than older people, or people with chronic medical conditions.

In addition, he said, those plans need to cover preexisting conditions.

“We need to focus on the care, and with all these preexisting conditions, we’re going to pay for it down the road,” Mosley told Healthline. “It’s all about controlling costs.”

Experts have told Healthline that several things can happen if ACA enrollment declines.

First, the pools can become expensive for insurance companies that now have more unhealthy customers than healthy ones.

This could cause some insurers to drop out of the ACA marketplaces.

It might also encourage them to raise insurance premiums across the board to make up for losses in the ACA plans.

In addition, uninsured people will skip preventative healthcare appointments and more of them will end up in emergency rooms for more serious health issues.

That can drive up medical costs.

Last year, several Republican governors and state attorneys general filed a federal lawsuit challenging the legality of the Affordable Care Act.

Two ACA provisions were at the center: preexisting conditions and the requirement to have adequate health coverage or pay a penalty when you file your taxes.

Originally under the law, those who didn’t have health insurance had to pay a maximum fine of about $700, a penalty Congress later lowered to zero.

In their lawsuit, the Republican state attorneys general argued the law’s individual mandate is unconstitutional after Congress zeroed out the penalty.

Last month, a Texas judge ruled in favor of the Republican leaders, saying the ACA law was indeed unconstitutional.

U.S. District Judge Reed O’Connor said the individual mandate “can no longer be sustained as an exercise of Congress’ tax power.”

Instead of gutting the law bit-by-bit, he argued the whole thing should be tossed out.

“Wow, but not surprisingly, ObamaCare was just ruled UNCONSTITUTIONAL by a highly respected judge in Texas,” Trump tweeted after the ruling. “Great news for America!”

Last week, a coalition of 17 attorneys general — led by California Attorney General Xavier Becerra — filed a brief in the Texas case, detailing the harm that ending the ACA will have on the U.S. health system, states, and millions of Americans.

Becerra says at stake is millions of Americans losing their healthcare.

“Every American could be affected by this case’s outcome: children, seniors, workers covered by employers or through the marketplace, and the hundreds of millions of people with a preexisting condition,” Becerra said in the statement. “This shouldn’t be a debate: The ACA is the law of the land, and we will continue to challenge this dangerous attempt to undermine Americans’ health.”

At the moment, the Affordable Care Act remains in effect.

O’Connor put a stay on his ruling, meaning it remains law until a higher court — in this case, the U.S. Supreme Court — weighs in on the matter.

The New York Times reported that the Supreme Court is often reluctant to strike down federal laws that have been so ingrained in people’s lives.

In addition, with more pro-universal healthcare Democrats now in the House of Representatives, it’s unlikely an ACA repeal would come via the legislature.

Larry Levitt, senior vice president at the Kaiser Family Foundation, wrote on Twitter that the Trump administration is arguing that the whole ACA shouldn’t be thrown out, but rather its preexisting condition protections “should be invalidated.”

“With Democrats taking control of the House, the biggest remaining threats to the ACA are administrative actions by the Trump administration and this lawsuit, which seems like a long shot but one never knows for sure,” Levitt wrote.

Mosley says often in American politics, people tend to criticize more than they compromise.

“It’s here to stay for now. In the interim, you can’t keep people in the lurch,” Mosely said. “Regardless of your political persuasion, you are as likely to get sick as the next guy.”