Despite court fight, consumers can shop like normal for health coverage

Don't let another round of reports about the Affordable Care Act's supposed demise deter you from buying health insurance through MNsure, the state's online marketplace.

Open enrollment, that annual window of time to buy coverage for the coming year, begins Nov. 1. The protections and aid provided by the law, which has survived two major legal challenges and now faces a third, won't instantly disappear even if a federal appeals court delivers an adverse ruling in the coming days or weeks.

MNsure, the marketplace established under the law, will still be open for business. And, consumers who buy insurance on their own will still be able to qualify for instant financial discounts available through the law to help pay monthly insurance premiums in 2020. The total amount of aid provided to help Minnesotans buy coverage this year: $225 million.

MNsure remains the only purchasing portal where Minnesotans can access this assistance. The website is already open for "window shopping" to allow consumers to comparison shop before open enrollment starts. Minnesotans will also have eight more days to shop for 2020 insurance than consumers in many other states. The last day to buy coverage here is Dec. 23. That's more than a week longer than consumers have in states that chose not to set up their own marketplace and instead rely on the federally run HealthCare.gov.

That the ACA, enacted under President Barack Obama in 2010, faces legal uncertainty again is frustrating. In the first challenge to it, opponents argued that the law was unconstitutional because it required consumers to have health insurance. In this latest challenge, the law's opponents claim it's now unconstitutional because the law essentially doesn't have that requirement. In 2017, Congress reduced the penalty to $0 for not having coverage.

The legal reasoning is dubious, but a Texas district court judge bought it last December. An appeal was filed and the nation is now awaiting the ruling from a three-judge panel on the Fifth Circuit Court of Appeals in New Orleans. In an unusual move, the Trump administration chose not to fulfill the traditional obligation of defending a federal law but instead advocated for it to be struck down.

If the ruling is appealed to the U.S. Supreme Court, which is expected no matter how the Fifth Circuit rules, the process will take time. That's why consumers can shop for 2020 coverage with confidence, no matter how the ruling comes down.

Consumers, however, should worry about future access to insurance. If the Supreme Court invalidates the ACA, it could be dismantled, ending the law's pre-existing condition protections, its subsidies to buy coverage, and its measures to close the prescription medication "doughnut hole" for seniors on Medicare. Expanded eligibility for Medicaid, a public program for the poor, could also be rolled back. An estimated 21 million Americans would be at risk of losing their health coverage, according to a recent New York Times analysis.

"Millions of Americans have found peace of mind in not worrying that their pre-existing condition will cost them their health or have been covered for the first time since the ACA," said Minnesota health care advocate and former health care executive Andy Slavitt. "For Trump to encourage the courts to put all that at risk is a radical sellout of the people he swore an oath to protect. And for the courts to cynically ignore the law and oblige this political folly is a full circle betrayal."

A recent poll suggests that the legal challenge has created consumer uncertainty about enrolling during open enrollment this year. For now, those relying on the ACA for access should shop and buy coverage as normal — and hope they'll be able to tap the law's help again in years to come.