A U.S. federal court judge has ruled that the Affordable Healthcare Act, otherwise known as "Obamacare," is unconstitutional – a ruling that could threaten access to health insurance coverage for approximately 10 million people.

These were people who had signed up for health insurance on the Obamacare marketplace. Also affected are tens of millions more who have pre-existing conditions.

Obamacare was approved by a Democrat-dominated Congress on the initiative of President Barack Obama in 2010, with no Republican support as they argued the federal government had no legitimate power to force people to purchase health insurance. 

That raises an immediate question: What impact could it have on healthcare access in the U.S. if this ruling is upheld on appeal, or if Obamacare is repealed by legislation?

First, the 10 million people who purchased individual health insurance plans via market exchanges will have to find new coverage. Most of these people have to live on low-to-moderate incomes; 80 percent of them receive some form of state subsidy. Without these subsidies, their out-of-pocket costs could increase.

At the same time, there might be new insurance plans with lower deductibles and less coverage available. Obamacare required that every insurance plan cover preventative care and a host of "essential benefits." Naturally, those benefits increase the cost of coverage. In 2018, the average deductible was US$4,000, and the scope of networks where those plans are accepted is becoming smaller.

Middle class beneficiaries who enrolled through the individual market could actually benefit from the end of Obamacare – if cheaper plans become available. This is what Republican senators Marco Rubio and Ted Cruz meant when they said that the ruling should put pressure on Congress to address the needs of Americans who have been "hurt by Obamacare."

Those with lower incomes who receive subsidized healthcare face significant hurt. Also likely to suffer will be a few million people who signed up for Medicaid, the healthcare program for the poorest Americans expanded under Obamacare. Americans earning US$200,000 or more should gain tax cuts, however, as the Medicaid expansion was paid for in part by an increase in payroll taxes on higher earners.

Young people and healthy people with few pre-existing conditions might have access to cheaper coverage, while people with expensive pre-existing conditions will have to pay much higher rates or have a harder time finding coverage, since requirements to cover the illnesses would be eliminated.

Drug companies and insurance companies would lose revenue from Obamacare being repealed or blocked by the courts. Millions more people having access to healthcare means billions more spent on insurance premiums and drugs. 

Obamacare did not actually do anything to address the structural causes of astronomical healthcare costs. It did not put pressure on drug prices. It did not allow the government to negotiate to force down drug prices or import medicines from overseas, for example. 

In fact, the Democrats cut a deal with the pharmaceutical lobby group to prevent them from opposing Obamacare. When Republicans sought to repeal the legislation, drug companies, insurance companies and hospital operators, all spent heavily in lobbying to avoid this action.

For the time being, however, nothing much will change. The ruling is going to be appealed, and Obamacare will remain in effect until there's a final judgment. 

Republican Senator John Cornyn said, "The status quo will be maintained," and nothing will happen until the Supreme Court rules on it "maybe in a couple of years from now." Top Democrat Senator Chuck Schumer said, "We are going to fight this tooth and nail."

Mitchell Blatt is a columnist with China.org.cn. For more information please visit:

http://www.china.org.cn/opinion/MitchellBlatt.htm

Opinion articles reflect the views of their authors, not necessarily those of China.org.cn.

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