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The high cost of treating COVID-19, its long-term health complications for those who recover, and the economic ramifications of the pandemic are driving home the value of the protections created under the Affordable Care Act – and how much trouble many Americans will find themselves in if the law is overturned.

A week after the presidential election, the U.S. Supreme Court is expected to hear arguments in a lawsuit brought by Texas and a group of Republican attorneys general that seeks to get rid of the Obama-era health-care law. An opinion is expected to be handed down next year.

If the court decides that the ACA should be tossed, more than 20 million people would lose health insurance they gained through the federal healthcare.gov, a state-based ACA marketplace, or Medicaid expansion.

Many more people, even some who get it through an employer, would be affected by the reversal of one of the law’s most popular insurance rules: protections for people with preexisting conditions. More than one in four people have a medical condition that, before the ACA, would have made them uninsurable.

“Insurance coverage is a little bit like a game of musical chairs,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation who studies health reform and private insurance. “With the ACA reforms, there was a much higher likelihood that if you lost your job, there would be another chair for you.”

Before the Affordable Care Act, insurers selling individual health plans were allowed to deny coverage entirely, exclude coverage for certain medical problems (or body parts), or charge higher rates for “riders” to a policy that would cover a person’s preexisting condition.

For instance, in one study of pre-ACA individual health plans, Pollitz found that insurers were willing to sell health insurance

Female doctors get paid less than male doctors, but a new study disputes the common wisdom that it’s because they work less.



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In fact, female doctors spend more time with patients, order more tests and spend more time discussing preventive care than their male counterparts, a team of researchers reported in the New England Journal of Medicine.

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“That raises the question of whether we are paying for what we really care about in health care,” said Dr. Ishani Ganguli, an internal medicine specialist at Harvard Medical School and Brigham and Women’s Hospital, who led the study team.

Ganguli and colleagues looked at billing and time data covering more than 24 million visits to primary care doctors in the US in 2017.

“We calculated that women were paid 87 cents to the dollar for every hour worked compared to their male colleagues,” Ganguli told CNN.

Female doctors spent an average of two minutes more per visit than men did. It doesn’t sound like much, but it adds up over time, Ganguli said. And they are not spending that time chit-chatting.

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“When you compare by visit, women actually did more during the visit,” said Ganguli, herself a primary care provider. “They put in more medical orders, they discussed more medical diagnoses and preventive care. They are spending more time per visit.”

Ganguli and her team did not sit in on visits, so they cannot say precisely what is going on. “We are using clues from billing information about what orders are put in, like for blood tests, or what diagnosis was talked about,” she said.

But other studies have indicated that patients and