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How The Future Of The ACA Could Affect Nevadans

A woman looks at the camera with a serious face. She's wearing glasses and a black shirt.
Lucia Starbuck
Reno resident Felicia Perez has several chronic illnesses. She says the ACA has enabled her to afford the treatments and prescriptions she needs.

During this week’s confirmation hearings, lawmakers have been grilling Supreme Court nominee Amy Coney Barrett on various legal issues, including her view of the Affordable Care Act. Next month, the law will be challenged in the nation’s highest court.

KUNR’s Anh Gray explores what’s at stake for Nevadans, and how dismantling the ACA could affect access to health care for many.

On the second day of the hearings, California Senator Kamala Harris, who is also the Democratic vice presidential nominee, defended the decade-old law.

She shared the story of Felicia Perez, who works part-time as a consultant and also as a lecturer in gender studies at the University of Nevada, Reno. She has a precancerous tumor wrapped around her optic nerve and other chronic ailments, like rheumatoid arthritis and anemia.

A screenshot from a web call. Senator Kamala Harris is holding a photo of Felicia Perez toward a web camera. Supreme Court nominee Amy Coney Barrett is looking away from a web camera.
Credit Screenshot / PBS NewsHour Via YouTube
PBS NewsHour Via YouTube
Sen. Kamala Harris, D-Calif., speaks at a confirmation hearing for Supreme Court nominee Amy Coney Barrett on Tuesday, Oct. 13. Harris defends the Affordable Care Act and shares the health struggles of Reno resident Felicia Perez.

“Felicia is terrified. She knows that without the Affordable Care Act, she could not afford ongoing treatment, the treatment she needs to stay alive," Harris said while holding up a photo of Perez. "And here’s exactly what she said, and I will quote: 'My life is in the hands of people, who I do not know, who do not know me, who are essentially telling me that I don’t matter, that my life doesn’t matter, that my health doesn’t matter, that the day-to-day quality of my life doesn't matter, and that’s really hard.' ”

KUNR first shared Perez’s story back in February. Perez is insured through her partner’s employer, which covers the bulk of her treatments and medication after she meets her annual deductible of more than $7,000.

“If I did not have insurance, and I had to pay out of pocket, it would cost somewhere near $200,000 a year,” Perez said. “Without my medical, you know, without insurance, I'm not able to come up with $200,000 a year outside of my everyday living expenses.”

The ACA requires all health insurance plans provide 10 essential health benefits, which include prescription drugs, preventive care and chronic disease management. In addition, the ACA eliminated denying coverage to people with pre-existing conditions as well as the annual and lifetime caps on benefits.

The Supreme Court will hear oral arguments in California v. Texas (Dkt. No. 19-840) regarding the constitutionality of the ACA a week after the general election. Several GOP senators pointed out that Barrett’s role is to make decisions based on the Constitution and not to legislate from the bench.

Back in 2017, Congress passed a law to cut taxes that reduced the individual mandate, which is the penalty for not having insurance, down to zero. The upcoming Supreme Court decision will determine whether losing the individual mandate renders the rest of the ACA unconstitutional. Over the last decade, Republicans have been promising to repeal the law, and a Barrett confirmation would tilt the balance of the court, making the ACA’s future unclear.

“What's happened with the Affordable Care Act is for the last 10 years, people have gotten a taste of something that no money and no medicine can provide,” Perez explained, “and that's called hope.”

Heather Korbulic heads up the Silver State Health Insurance Exchange and runs Nevada Health Link, the online marketplace, which currently provides affordable health insurance to 77,000 Nevadans.

“Before the ACA, people could have a health condition that would cost a lot of money to treat,” Korbulic explained, “and insurance companies could put a lifetime cap on the number of dollars that they would spend on that treatment, leaving people responsible for the full cost of their care, if they were to reach their lifetime cap.”

Under the ACA, insurance companies are required to cover pre-existing conditions. In addition, the federal government provided subsidies to states that opted into a Medicaid expansion. More than700,000 Nevadans are currently covered, but Korbulic says if the entire ACA is struck down, those federal subsidies would go away.

“If the ACA is to be repealed at a national level, then there [are] no Medicaid match dollars that come into the state to support all of these additional lives that are on Medicaid,” Korbulic said. “We're talking billions of dollars that come to our state. And then suddenly we'll see that the price of health insurance is so significantly high, that it will be out pricing most Nevadans who are currently insured.”

John Packham is a health care policy expert. He’s the Associate Dean of the Office of Statewide initiatives at UNR’s School of Medicine.

“A ruling that would strike down the Affordable Care Act, would be an invitation to chaos,” Packham explained, “and stakeholders in healthcare have spent the last decade ramping up and preparing, changing business models to accommodate provisions. And the idea that we would turn that system on its head in the middle of the pandemic is...it's staggering.”

Packham said even with the benefits of the ACA, there’s still room for improvement, especially since so many still heavily rely on employer-based insurance for coverage.

“Both its strength and weakness is that it is built on our foundation of employment-sponsored health insurance,” Packham said. “What we're seeing right now is, again, a lot of turmoil in coverage, due to the fact that people are losing jobs.”

According to the U.S. Bureau of Labor Statistics, Nevada’s unemployment rate is about 13%, which is the highest nationwide. Many have lost their employer-based health insurance. And for Felicia Perez, knowing her access to affordable health care hinges on the upcoming Supreme Court ruling, has been an emotional rollercoaster.

“The further away I get from death and the healthier I become," Perez said, "the more scared I become at dying and everything that I have to lose.”

Right now, the pandemic has exacerbated concerns about health care. Medicaid enrollment has increased by about 14% statewide.

The screenshot included in this story is from PBS NewsHour's YouTube video titled WATCH: Sen. Kamala Harris questions Supreme Court nominee Amy Coney Barrett from Oct. 13, 2020. View the video on YouTube.

Anh Gray is a former contributing editor at KUNR Public Radio.
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