Many in Florida are bracing as the Supreme Court hears arguments Tuesday that will determine the fate of the Affordable Care Act.

What You Need To Know

  • Supreme Court to hear arguments Tuesday on constitutionality of Obamacare

  • More people have registered for ACA coverage in Florida than in any other state

  • Proponents cite lower costs, other benefits; opponents say many aren't getting needed care

The signature policy of former President Barack Obama brought health insurance to about 20 million people, and it remains especially popular in Florida, where more people registered for coverage this year than in any other state.

The Affordable Care Act, popularly known as Obamacare, created exchanges or marketplaces through that allow people to browse health care options outside of an employer plan.

Proponents say the law has lowered costs for consumers. They also point to key consumer benefits. For example, the ACA prohibits insurers from denying coverage because of pre-existing conditions, and the law allows young adults to remain on their parents’s plans until age 26.

“The bottom line, it’s a great deal for people,” said Anne Swerlick, senior policy analyst at the Orlando-based Florida Policy Institute.

But opponents, including some doctors, maintain that high costs and deductibles are preventing some patients from getting the care they need.

“It’s done so much damage,” said Dr. Suvarchala Dara, an Orlando cardiologist.

Almost 2 Million Floridians Enrolled

Yet Floridians continue to demand it. Some 1.9 million Florida residents enrolled in plans though the exchange for the 2020 benefit year.

The open enrollment period for 2021 continues through December 15, and Florida could be on its way to again leading the country in Obamacare enrollment.

“It's been very busy,” said Jodi Ray, program director of Florida Covering Kids & Families, a University of South Florida initiative that says it works to provide education, training, and enrollment assistance to help individuals obtain health care coverage. “We’re working all day doing applications, for hours and hours, because there are so many people who need help.”

Ray pointed to the economic effects of the coronavirus pandemic, which has claimed hundreds of thousands of jobs and more than 17,000 lives in Florida.

The pandemic especially has hit the service industries in Tampa Bay and Central Florida. Hotels that have laid off workers have referred employees to the USF College of Public Health initiative, Ray said.

Swerlick, the Florida Policy Institute senior policy analyst, said Florida’s refusal to expand eligibility for Medicaid could contribute to high Obamacare enrollment in the state. Florida remains among 12 states that have not adopted Medicaid expansion, according to the Kaiser Family Foundation.

“In Florida, we don’t have much of a safety net for people who can’t afford insurance,” Swerlick said.

About 2.7 million Floridians remain uncovered, and that doesn’t include hundreds of thousands whose families could be left without company-sponsored health insurance because of the pandemic, she pointed out.

All Eyes on the Supreme Court

That’s why so many people are keeping an eye on the Supreme Court. Even though the court isn’t expected to decide on the Affordable Care Act until well into next year, justices could provide hints during Tuesday’s arguments on where they stand on the law — and whether Obamacare will survive.

Proponents express particular concern because the Supreme Court now holds, with the addition of Justice Amy Coney Barrett, a solid 6-3 conservative majority.

The court upheld the law in 2012, ruling the so-called individual mandate constitutional, as a tax that Congress could impose. The individual mandate at the time carried a penalty for Americans who failed to get health care. Republicans later passed legislation that cut that penalty to zero dollars.

Now, Florida stands among 18 states, led by Texas, that present another lawsuit on the ACA’s constitutionality, especially given that the individual mandate no longer carries a penalty.

Observers point out that the court could take any number of actions, including to strike down certain provisions, the individual mandate, or the entire law. Reports say many experts think justices will take no action at all.

ACA proponents warn that the death of Obamacare would have dire effects on millions of Americans and the economy, including Florida’s. A group called the Florida Health Justice Project includes on its website a letter, dated October 26, that appeals to Florida Attorney General Ashley Moody to withdraw Florida as a plaintiff in the California v. Texas lawsuit.

“In the coming months, the ACA will play a crucial role in Florida’s ability to manage the COVID-19 crisis,” the letter says. “With or without a vaccine, it is imperative that the maximum number of Floridians have access to affordable treatment. From a public health standpoint, an increase in Florida’s uninsured population would be disastrous, as the uninsured often avoid seeking necessary medical attention.”

“It's quite alarming to think potentially what could happen if the law is overturned,” said the Florida Policy Institute’s Swerlick. The ACA’s benefits extend even to those on Medicare, she pointed out.

Like others, Ray of the USF initiative said she found it difficult to predict what the Supreme Court might do. But to strike down Obamacare would “have a huge impact on our health care system.”

A Tampa Lawyer’s View

Craig Rothburd, whose Tampa law practice handles health care compliance among other legal areas, discussed the Supreme Court case with Spectrum News on Monday. He said he spoke from a practical perspective.

“It’s more of a feeling than it is a legal opinion, that the court doesn’t want to touch that because its impacts are too wide,” Rothburd said of the ACA. “It has already held that the Affordable Care Act is constitutional, and there’s too many bad consequences from a decision to invalidate it.”

Yet Dara, the Orlando cardiologist, said she hopes that’s what happens.

Too many older patients are unable to pay for tests or special procedures because of high deductibles, she said. That leaves her in a position of having to decide whether to charge patients for her services.

“Because I’m a woman and I’m more compassionate, we eat up the cost, and I say, ‘Listen, this is a service that I’m doing for the public,’” said Dara, who said she runs a private practice.

But she said most cardiologists and physicians are unable to do that. As a result, she said, such patients tend to go from one doctor to another in search of treatment.

The Affordable Care Act “has driven so many issues,” Dara said. “What we have to do is come up with an alternative plan.”

“I hope this is struck down,” she said. “But then what would happen with this chunk of patients? We have to figure that out.”