As President-elect Biden prepares to assume office on January 20th and Congress completes work on the fiscal year 2021 budget, the U.S. Supreme Court met the week after the election to hear oral arguments in a case which could overturn the Affordable Care Act (ACA), also known as “Obamacare”, and eliminate protections for millions of Americans living with pre-existing conditions like myotonic dystrophy. The Myotonic Dystrophy Foundation (MDF) has been closely monitoring these events and continues to advocate with our elected officials to maintain these protections.

Following this week’s events, we anticipate the court will render a decision on the case in June. Given the types of questions the justices asked in this week’s presentations, we are hopeful the court will decide to reject the case and maintain the law and the pre-existing protections.

We anticipate the new Congress will be politically divided with the Democrats holding a narrower majority in the House of Representatives and the Republicans retaining an even narrower margin in the Senate. There will be two run-off elections in Georgia in January. If the Democratic candidates were to win both of those seats, the Senate would be divided 50-50 with Vice President-elect Harris serving as the tiebreaking vote.

Regardless, President-elect Biden will face a narrowly divided Congress which will require both sides to compromise on new insurance protections in the event the ACA is overturned.

The law, passed by Congress during the Obama Administration, provides health insurance coverage for 20 million Americans through health insurance marketplaces and expanded Medicaid coverage. Additionally, the ACA prohibits health insurance companies from denying coverage or charging high health insurance rates to individuals with pre-existing health conditions.

A key feature of the law is a requirement that uninsured Americans buy health insurance coverage or pay a modest financial penalty to the government. Subsidies are provided for individuals and families who meet the law’s financial thresholds. For lower-income Americans, states were encouraged to expand Medicaid eligibility and received a high federal contribution if they did so. While the law’s authors believed this component was necessary to establish more sustainable health insurance plans with more affordable premiums, several States and the Trump Administration argued that compelling Americans to buy health insurance exceeded Congressional authority under the constitution. However, public support for Obamacare has increased steadily since its passage a decade ago.

While the ACA isn’t perfect, it has extended health insurance coverage to millions of Americans and protected even more Americans living with pre-existing conditions like myotonic dystrophy. MDF will continue to work with Congress and the new Administration on efforts to improve access to affordable, quality health insurance coverage and we encourage all MDF advocates to join us in this important work.