On November 10th, the Supreme Court of the United States will conduct a hearing on a topic of great concern to millions of people with chronic health conditions such as idiopathic hypersomnia and related sleep disorders. The question before the court is whether all or a part of the Affordable Care Act (ACA) is unconstitutional. The Supreme Court ruling, which isn’t expected until summer 2021, has the potential to impact health and prescription drug insurance coverage for millions of Americans, including thousands of individuals with hypersomnias currently covered by ACA policies and protections. The Board of the Hypersomnia Foundation has been following this court case out of concern for the significant impact it may have on our community.
What Is the Case About?
Like many Supreme Court cases, it’s complicated! In brief, it is possible that the Affordable Care Act will be deemed unconstitutional and the programs currently providing insurance to many people with hypersomnias will be dismantled.
Due to the death of Justice Ruth Bader Ginsburg and the changing makeup of the Supreme Court, media outlets from across the political spectrum have written a flurry of articles describing the court case and discussing possible outcomes. These two articles from media outlets on different parts of the political spectrum both provide a simplified, straightforward overview of the case and possible outcomes:
- FOX news article “Ginsburg’s death casts fresh uncertainty on the Affordable Care Act’s future”
- NPR article “The Future of the Affordable Care Act in a Supreme Court without Ginsburg”
For a more detailed description of the case, the various states and parties participating in the case, and the legal arguments involved, this article by the Kaiser Family Foundation provides a comprehensive overview:
- KFF article “Explaining California v. Texas: A Guide to the Case Challenging the ACA”
What’s at Stake?
Having a hypersomnia diagnosis as a pre-existing condition means that our community is particularly vulnerable to the loss of ACA protections. For those unable to maintain full-time employment due to their hypersomnia, ACA programs and requirements for insurers are even more important for maintaining insurance coverage and accessing treatment. Before the ACA became law, insurers could charge higher premiums for pre-existing conditions or deny coverage altogether. With the high cost of many medications used to treat IH and related sleep disorders, our community benefits greatly from ACA requirements to provide coverage with equal premium pricing in each cohort without regard to health status.
Whether you are insured through your employer, an individual policy through the ACA marketplace, Medicaid or Medicare, losing ACA requirements and protections would have many implications on access to coverage and the affordability of policies. For example, the ACA requirement to cover dependent children until age 26 applies to all policies, even those provided by employers. The following article lists potential implications for each source of insurance:
- CNN article “The future of Obamacare is at risk again. Here’s what’s at stake.”
The loss of the ACA would likely have a disproportionately negative impact on communities of color and underserved populations. As the Hypersomnia Foundation Statement of Values specifies Inclusiveness, our Board is concerned that loss of ACA policies and provisions will deepen existing disparities in the diagnosis and treatment of hypersomnias. Healthcare policy organizations such as the Commonwealth Fund have conducted analysis that demonstrates the positive impact of the ACA and Medicaid expansion on insurance coverage for historically underserved populations. Logically, those who have gained the most from the ACA are likely to lose the most if the law is overturned.
The Importance of Your Vote
Like all rare and chronic illnesses, IH and related sleep disorders impact people of all political persuasions. Those of us on the Board, our many volunteers, and our vast community of patients, supporters, clinicians, and researchers have many reasons for choosing the issues we care about and the candidates we support.
If the Supreme Court declares the ACA unconstitutional, then Congress and the President have the ability to change the law to resurrect the ACA or to pass new laws to replace the ACA with something else. As voters, we have a voice in selecting the lawmakers who will be making these decisions. With this article covering the challenge to the ACA, we hope we have provided you with useful information on this important issue.