Yesterday, the Fifth Circuit Court of Appeals heard oral arguments in Texas v. Azar, the latest legal challenge to the Affordable Care Act (“ACA”).  Seventeen States and two individuals sued in 2018, arguing that Congress’s choice to zero out the individual mandate in 2017 renders the entire ACA unconstitutional.  After the Trump administration refused to defend the law, the House of Representatives and eleven states, including Oregon, stepped in for the government.

OSPIRG supported the ACA in 2009, and we have consistently fought for its preservation and successful implementation throughout the following decade.  In Oregon’s 2019 legislative session, we successfully advocated for passage of Senate Bill 250, which codifies a number of the ACA’s consumer benefits in Oregon law – including protection for individuals with preexisting conditions.

In light of this week’s proceedings, it’s important to take stock of what Oregon stands to lose if the court decides to strike down the ACA.

The Individual Insurance Market

Oregon had a rocky start implementing its online insurance exchange under the ACA with the much publicized collapse of “Cover Oregon.”  However, after switching to the federally managed platform Healthcare.gov, Oregon has had great success in enrolling consumers on the individual market.  Before the ACA, about 17% of Oregonians were uninsured – today, that figure has been reduced to 5%.

In spite of federal efforts to disrupt the market, Oregon’s health insurance exchange has remained stable, with 148,479 Oregonians finding coverage for 2019 on the exchange.  After better than expected 2019 results, insurance Rates for 2020 appear to have stabilized, with some carriers actually decreasing premiums for the year.

All of this progress could be jeopardized by the Texas lawsuit.  If Healthcare.gov is shut down, Oregon will need to create a new marketplace from scratch.  The Court could also eliminate advance premium tax credits that help tens of thousands of Oregonians afford their insurance.

Insurance Losses – Marketplace & Medicaid Expansion

In addition to cutting tax credit support for individuals on the marketplace, ACA repeal would roll back the expansion of Medicaid, which is currently 90% federally funded.  In 2019, almost one million Oregonians are covered by the Oregon Health Plan, the state’s Medicaid program.  

Between the loss of Medicaid funding and tax credits, an estimated 372,000 Oregonians would lose health insurance.

Consumer Protections

Furthermore, ACA repeal would roll-back numerous pro-consumer policies at the Federal level, including protection for individuals with preexisting conditions, allowing young adults to remain on their parent’s health plan up to age 26, and guaranteed coverage for the 10 essential health benefits. In Oregon, many, but not all of the ACA’s protections have been written into state law.

Even though Oregon has shown a commitment to preserve these policies through the passage of Senate bill 250 in 2019, an adverse ruling in Texas v. Azar would likely force reconsideration and potentially rollback of many consumer protections in Oregon.