Keep ACA protections against million-dollar medical bills

"I opened it and said 'Holy [bleep]!' " That was Michael Flor's reaction when the massive bill arrived for his stay in a Seattle-area hospital after he contracted COVID-19.

The bill's 181 pages detailed charge after charge for a 62-day stay, according to the Seattle Times. The total: $1.1 million. Fortunately, Flor has good insurance that will pick up most of the tab. At age 70, he's on Medicare, the federal government-run plan for seniors.

The size of Flor's bill doesn't just underscore the need to have health care coverage during a pandemic. The staggering sum also serves a timely warning about wiping out consumer-friendly insurance reforms, such as ending lifetime limits on personal medical expenses under the Affordable Care Act (ACA). These vital protections are reprehensibly in jeopardy yet again with a third legal challenge headed to the U.S. Supreme Court.

Before the ACA's passage in 2010, private health insurers could limit how much they would pay out for individual enrollees' care. The lifetime ceiling was often $1 million or more — high enough that most people wouldn't reach it. Still, it could happen, with premature babies or organ transplant patients examples of those who could exceed coverage caps.

Flor's huge bill illustrates how quickly COVID-19 care costs can add up. Just one hospitalization, for a contagious illness that could be contracted almost anywhere, could put many people over old lifetime limits.

That reality makes a pandemic an especially irresponsible time to try rolling back protections like lifetime limit bans or other ACA reforms, such as safeguards for those with pre-existing medical conditions. Unfortunately, that could be the outcome of the case expected to be heard by the Supreme Court later this year.

The lawsuit is now known as California v. Texas but typically just referred to as the "Texas case." A group of GOP state attorneys general, led by the Texas attorney general, initiated the suit in 2018. They argued the entire law should be overturned because of a change to the ACA made by Congress in 2017. That change was in effect a consolation prize after lawmakers failed to repeal the law. Congress instead settled for gutting the ACA's "mandate" to purchase coverage by reducing the penalty to $0.

Opening briefs filed June 25 by the Texas-led coalition and the Trump administration have put the legal challenge back under the spotlight, although a ruling isn't expected until 2021. A legal analyst recently summed up the stakes. "All parties maintained their position that the entire Affordable Care Act (ACA) should be declared invalid by the Supreme Court," attorney Katie Keith wrote in a post for the Health Affairs policy journal.

If the law is overturned, it won't just be consumer insurance protections like the lifetime limit bans that are tossed aside. Gone too would be the financial assistance provided through the law to those who buy private insurance on the individual market and the law's "doughnut hole" provisions that make seniors' prescription medications more affordable.

A broad coalition of groups have already filed "friend of court" briefs asking the high court to uphold the ACA. Among them: the American Medical Association, the American Hospital Association and the nation's insurers. Using a judicial wand to wave away the law's protections and assistance for buying coverage would cause "widespread disruption" in the best of times, warns the AHIP, the trade organization for health insurers. Doing so in the midst of a pandemic would be "reckless and dangerous."