The recent death of Justice Ruth Bader Ginsburg, and President Trump’s vows to replace her on the Supreme Court as soon as possible, have increased the possibility that the Affordable Care Act could be overturned in the midst of a pandemic.

We spoke with our colleague Abby Goodnough, who covers health care for The Times, about the potential consequences if some or all of the law is overturned.

Coverage: Roughly 21 million Americans are at serious risk of losing their health insurance if the A.C.A. is overturned. Millions of Americans have already lost their job-based health insurance during the current crisis, and many have relied on Obamacare as backup coverage. “It has been a huge safety net,” Abby told us. “The last thing you want is to get the coronavirus and then not have insurance pay for the really expensive medical care that comes along with it. And a lot of people are already facing that.” While there are temporary provisions to help Americans pay for medical expenses related to the coronavirus, the funding for these programs is finite.

Vaccines: The A.C.A. includes a mandate for insurers to cover preventive care, much of it for free, and that includes vaccines. When effective coronavirus vaccines arrive, we are assuming it will be free because of a provision in the A.C.A., Abby said.

Pre-existing conditions: Obamacare bars insurers from refusing to cover people with pre-existing health conditions. Contracting the coronavirus, which leaves many patients with lingering health problems, could make it difficult or impossible for people to get health insurance in the future if part or all of the A.C.A. is invalidated.

Hospitals: The A.C.A. has strengthened the financial health of many hospitals, in part by expanding Medicaid, which covers poor Americans. When Medicaid recipients make trips to the hospital, the hospitals are reimbursed for some of the cost, whereas in the past they might have received nothing.

Underlying health: Many studies have shown that Obamacare has generally helped with overall health outcomes. Guaranteeing preventive care could help ward off the chronic conditions like obesity and diabetes that increase the chances someone will become seriously ill from the virus.


Parents — and even children — might want to brace themselves before reading this: Adults may be able to get a coronavirus vaccine by next summer. But kids will have to wait longer. Perhaps a lot longer.

While a number of vaccines for adults are in advanced clinical trials, there are currently no trials in the United States for children.

“Right now I’m pretty worried that we won’t have a vaccine available for kids by the start of next school year,” said Dr. Evan Anderson, a pediatrician at Children’s Healthcare of Atlanta and a professor at the Emory University School of Medicine.

Children’s vaccine needs are different than those of adults. Pediatric immune systems can respond differently to a vaccine, and even children among different age groups might vary in their responses. And because children are less likely to get seriously sick from Covid-19, the bar will be especially high to make sure there are no adverse side effects.

Whenever pediatric trials do begin, it could take a year or more for the vaccines to become available to the general public. That extends the timeline out until the latter half of next year, said Carl Zimmer, who reported the story for The Times. “If children are vaccinated by the fall of 2021, and if the rates are low in their community, you can imagine getting back to life as normal,” he told us. “But if rates are still high and vaccines aren’t ready until spring of 2022, then all the stuff we’re struggling now with kids in school will still be continuing a year from now.”

His takeaway? “Everybody’s got to get ready for a long winter.”


Here’s a roundup of restrictions in all 50 states.



I’m trying to focus on the election. I’m writing postcards to voters in other states and I’m hoping thousands of others are doing to same so that we have record turnout in November.

— Alexa Sorock, Evanston, Ill.

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