[Congressional Record Volume 166, Number 184 (Sunday, October 25, 2020)]
[Senate]
[Page S6533]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



       Americans who no longer face caps on expensive treatments

  The law protects many Americans from caps that insurers and employers 
once used to limit how much they had to pay out in coverage each year 
or over a lifetime. Among them are those who get coverage through an 
employer--more than 150 million before the pandemic caused widespread 
job loss--as well as roughly 15 million enrolled in Obamacare and other 
plans in the individual insurance market.
  Before the A.C.A., people with conditions like cancer or hemophilia 
that were very expensive to treat often faced enormous out-of-pocket 
costs once their medical bills reached these caps.
  While not all health coverage was capped, most companies had some 
sort of limit in place in 2009. A 2017 Brookings analysis estimated 
that 109 million people would face lifetime limits on their coverage 
without the health law, with some companies saying they would cover no 
more than $1 million in medical bills per employee. The vast majority 
of people never hit those limits, but some who did were forced into 
bankruptcy or went without treatment.

                               60 Million


Medicare beneficiaries would face changes to medical care and possibly 
                            higher premiums

  About 60 million people are covered under Medicare, the federal 
health insurance program for people 65 and older and people of all ages 
with disabilities. Even though the main aim of the A.C.A. was to 
overhaul the health insurance markets, the law ``touches virtually 
every part of Medicare,'' said Tricia Neuman, a senior vice president 
for the Kaiser Family Foundation, which did an analysis of the law's 
repeal. Overturning the law would be ``very disruptive,'' she said.
  If the A.C.A. is struck down, Medicare beneficiaries would have to 
pay more for preventive care, like a wellness visit or diabetes check, 
which are now free. They would also have to pay more toward their 
prescription drugs. About five million people faced the so-called 
Medicare doughnut hole, or coverage gap, in 2016, which the A.C.A. 
sought to eliminate. If the law were overturned, that coverage gap 
would widen again.
  The law also made other changes, like cutting the amount the federal 
government paid hospitals and other providers as well as private 
Medicare Advantage plans. Undoing the cuts could increase the program's 
overall costs by hundreds of billions of dollars, according to Ms. 
Neuman. Premiums under the program could go up as a result.
  The A.C.A. was also responsible for promoting experiments into new 
ways of paying hospitals and doctors, creating vehicles like 
accountable care organizations to help hospitals, doctors and others to 
better coordinate patients' care.
  If the groups save Medicare money on the care they provide, they get 
to keep some of those savings. About 11 million people are now enrolled 
in these Medicare groups, and it is unclear what would happen to these 
experiments if the law were deemed unconstitutional. Some of Mr. 
Trump's initiatives, like the efforts to lower drug prices, would also 
be hindered without the federal authority established under the A.C.A.
  Repealing the law would also eliminate a 0.9 percent increase in the 
payroll tax for high earners, which would mean less money coming into 
the Medicare trust fund. The fund is already heading toward 
insolvency--partly because other taxes created by the law that had 
provided revenue for the fund have already been repealed--by 2024.

                               2 Million