The US Supreme Court considers President Barack Obama's Affordable Care Act on 10 November. There are tens of millions of Americans whose access to healthcare could drastically change as a result of their ruling. Here are their stories.
Allie Marotta has heard the tales of people giving up their dreams in exchange for a job which provides health insurance. She says the Affordable Care Act (ACA) is why she's been able to still pursue hers.
Diagnosed with type 1 diabetes in 2006, Marotta describes it as a "fatal illness that's made chronic by the use of medication". Without access to insulin, death takes a matter of hours. Marotta also has celiac disease - a common autoimmune combination.
Marotta says she couldn't have entered the performing arts industry in New York City without the ACA's provision allowing children to stay on their parents' plans until age 26. After the pandemic hit, she's struggled with work, but is still able to access health coverage.
"In my community, no one has health benefits for a job because performing arts is all independent contractors and freelance," she notes, adding that she's helped many friends navigate the marketplace system.
It's the same story for gig workers, restaurant staff and those in hospitality across the country. But in the years since its enactment, prices for many marketplace plans have risen to hundreds of dollars per month. Marotta says when she aged off her parents' coverage in December, she couldn't afford to pay for the plans she qualified for under the ACA.
"It's already so flawed, and this is the only crumb you're willing to give the American people," Marotta says. "It was already difficult for me to access the ACA, and you're taking that away?"
What is the point, she wonders, of a health system that only works for the healthy?
The ACA brought health insurance coverage to millions of Americans when it was signed into law back in 2010. It was a campaign promise of candidate Donald Trump's to repeal and replace it but he's been unable to do that so far in his first term.
The Trump administration's work to dismantle the act has now culminated in a question of its constitutionality. Next month, it'll be before a conservative Supreme Court, with President Trump's third justice Amy Coney Barrett potentially on the bench, and it's uncertain what its fate may be.
The Supreme Court will rule on whether the act's individual mandate that everyone must buy health insurance is in line with the Constitution.
If the mandate is a no-go, then the court must also decide if the rest of the act can limp on as things are - or if it's unconstitutional in entirety. If it's the latter, protections for patients with pre-existing conditions, federal subsidies and aid expansions for lower-income Americans are also gone.
To Republicans, the ACA represents a drastic, expensive move into socialist healthcare - one that increases costs but lowers the quality of care. And national health spending did increase from $2.6tr in 2010 to $3.65tr in 2018, though the act wasn't entirely to blame.
It's also been unpopular among already-insured Americans who saw their coverage costs rise as sicker individuals were added to the pool. Some conservatives also view the act as an overstep of the federal government, an intrusion into the doctor-patient relationship.
The real question, of course, is how the row over fine print in Washington translates to a bottom line for patients.
Out of the 23 million Americans who are currently insured by the ACA or expanded Medicaid programmes, 21 million could lose their insurance if the act is overturned. Down the road, more could drop their plans if a lack of federal subsidies sends insurance prices sky-high.
And the backdrop to all this - a global pandemic that's affected more than 7.5 million Americans. Given the damage Covid-19 can do to the body, and the unknown number of related complications it may cause survivors, contracting the virus in 2020 could become a pre-existing condition in the eyes of insurers down the road.
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