The United States Supreme Court heard yet another case this week that could bring down the Patient Protection and Affordable Care Act, known as the ACA. The justices bantered with lawyers about “standing” and “severability”, words we don’t usually use in the day-to-day world. The live arguments and the supporting trial briefs can be confusing, but the impact of the ACA on children’s lives is clear and easy to understand: nearly one million children received coverage through the ACA and even more secured vital health care benefits.

The ACA wasn’t designed specifically to expand children’s health care, but the law created new pathways to coverage for them. Kids gained coverage when their parents interacted with the marketplace or enrolled in Medicaid; former foster youth were permitted to stay on Medicaid until age 26, and other young adults could remain on their parents’ coverage to age 26. Children with disabilities, chronic ailments, or life-threatening diseases need coverage for pre-existing conditions and must be protected from hitting annual and lifetime limits. The loss of the ACA would affect many areas of children’s health and lives and would threaten the health and economic stability of their families. The ACA is so important for kids that First Focus on Children filed an amicus brief with the court. 

Taking place against the backdrop of a COVID-19 pandemic spreading wildly across the country, the economic fallout from that pandemic, and last week’s election of Joe Biden and Kamala Harris to the presidency and vice-presidency, the timing of today’s hearing seemed hard to believe. The very idea of striking down the law that covers pre-existing conditions — which, going forward, will likely to include COVID-19 — that expanded Medicaid for adults who live in poverty and often secure coverage for their eligible children as well; that eliminated annual and lifetime limits in private insurance, feels preposterous right now. Children have been deeply harmed physically, economically, and socially by the pandemic. Now is not the time to end their health care.

Some of the justices passed surprising comments today, such as when conservative Justice Brett Kavanaugh seemed to question the argument that the law must fail if the individual mandate is deemed non-severable from the rest of the ACA. But I long ago learned not to predict Supreme Court decisions (remember the Medicaid expansion decision?).

While many listened to the hearing and came away with predictions, I just can’t work that way. Instead, we at First Focus on Children and the First Focus Campaign for Children, will continue to work on policies and protocols that keep kids covered, help make up for the losses in coverage we’ve seen in the last three years, and tell stories that show the importance of the ACA to children.