Is the nation really ready for the possible dissolution of the Affordable Care Act? If the Supreme Court rules that federal health insurance exchanges in 34 states cannot offer subsidies to help consumers purchase coverage, it isnt yet clear if that would start a death spiral for the law, which is what its opponents dearly hope.
On Day 1 after an adverse decision for the Obama Administration, opponents will rejoice. But if the law unravels, they along with everyone else will lose a lot of health security.
A wide range of programs under the ACA could soon go away: Expansion of community care centers in medically underserved regions, accountable care organizations, population health management, coverage for persons with pre-existing medical conditions, coverage on parental policies for adult children up to age 26, and lower prescription drug costs for many persons, particularly those on Medicare.
Its also uncertain what will happen to the information technology initiatives in the ACA. In addition to state insurance exchanges, they include HIPAA operating rules to better standardize electronic claims and related transactions; new HIPAA transactions for electronic fund transfers and claims attachments; expansion of data analytics fueled with the availability of Medicare claims data; a health plan identifier; electronic enrollment in health and human services programs; and the much-despised tax on medical devices.
What stays and what goes? What happens to accountable care organizations? What happens to population health management?
A lot of stakeholders wouldnt mind seeing the device tax die, but now that Medicare increasingly is making its data available for analysis, who wants to see that go?
A lot of families including those opposing the law have greatly benefited from keeping adult children on their insurance coverage longer or having coverage for pre-existing conditions. Care costs for newly uninsured patients wont just vanish; there still will be a societal impact from a radical change in direction.
For instance, HealthPocket, which has a free website that compares and ranks health insurance plans, analyzed rate filings for 3,771 plans in 45 states, finding an average premium increase in 2016 of 12 percent, with some plans expected to be 20% percent higher. Given the possibility of subsidy loss on Healthcare.gov due to the King v. Burwell Supreme Court case, 2016 rate proposals are receiving considerable attention, says Kev Coleman, head of research and data at HealthPocket. A principal concern is whether these rates are affordable in the potential absence of subsidies.
The reality likely is that if the Obama Administration significantly loses the court case, it will take time to sort out what remains of the Affordable Care Act, so benefits of the program wouldnt immediately disappear. But over time, many of the provisions that people take for granted today could be imperiled, and opponents of the law will scream just as loud as anyone else when that occurs.
I wonder if opponents losing benefits will remember that it was their Family Values associations and publications including American Family Association, Family Research Council, Citizens United and National Review that worked hard over the years to take away those benefits. ObamaCare may dissolve, but the underlying issues will remain, vexing and unsolved.
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