To say there is a lot riding on the Supreme Court’s upcoming health care decision (due sometime in the next week or so), would be overstating the obvious. It’s being hailed as “The Decision of the Century,” although one could argue that Bush v. Gore might have kept us out of Iraq, and therefore saved the country about $1 trillion.
If the Supreme Court’s decision strikes down the Affordable Care Act or its federal mandate, it will impact the parts of the ACA that are already in place: Coverage for young adults on their parent’s health insurance until they are 26, better Medicaid prescription benefits, preventative care without copayments for seniors and working-class families, and no pre-existing conditions for children. All of which are popular programs—even amongst people who are opposed to “Obamacare.”
“If not the ACA, then ‘What will happen next?’ is the question we need to be asking,” said Bill Wehrle, Vice President of Health Insurance Exchanges for Kaiser Permanente. “Right now, that part of it is lacking. If it’s not going to be this federally mandated system, then what will it be? Will we go back to the old system? Single payer? If you can’t have a mandate, what can you have?”
Early answers to those questions came on Monday, June 11 when UnitedHealthCare, one of the nation’s largest health insurance providers, promised to continue allowing young adults under 26 to remain on their patents’ plans, ending lifetime caps on benefits, providing preventative services (like cancer and diabetes screenings) without a copay, and not cancelling policies retroactively—regardless of what the Supreme Court decides.
UnitedHealthCare is the first major health insurance company to officially embrace the most popular provisions of the ACA that have already been enacted. The real test of the health care industry—especially if the law or the mandate is struck down—is how far insurers are willing to go in order to help cover America’s approximately 50 million uninsured.
However, if the court upholds the act and its mandate, expect a Tsunami of bureaucratic activity by the health insurance industry, state and federal governments, and health care professionals—not to mention a full-court political press by Republicans to repeal the law.
If the court upholds the ACA but not the mandate, expect a flood of uncertainty about the future of health care in this country. The level of gridlock generated by that decision could create a wake of problems for all levels of government and the entire health care system not seen since Katrina.
A New York Times article by Jonathan Weisman and Michael Shear speaks to the level of groundwork happening on both sides of the issue. From the Republican National Committee to the National Republican Congressional Campaign to the Democratic National Committee to Families USA to America’s Health Insurance Plans, virtually everyone with a stake in the game is prepared for whatever comes and has contingency plans mapped out several moves ahead: “Since Republicans believe that health insurance companies are contractually obligated to maintain some of the most popular provisions, like allowing adults under age 26 to remain on their parents’ health plans or ending lifetime payment caps, until the next open insurance enrollment period, they contend there will be less pressure on Republicans to produce the “replace” part of their promise to “repeal and replace” the Affordable Care Act. Republicans say their view was bolstered by recent signs from the health insurance industry that they will retain some popular benefits.”
According to Wehrle, regardless how the court decides, “It is difficult to imagine a system where everyone has a right to receive benefits but no corresponding obligation to participate in the financing of that system: See Greece.”
Whatever the court decides, it will affect all 50 states equally; however, there will be differences in how individual states respond to the decision—including a plethora of possible policies and programs.
As an uninsured cancer survivor with a pre-existing condition living in Colorado, what most concerns me is how the court’s decisions will impact my medical choices and my level of access to care here in my home state.
According to a March 2012 report from healthcare.gov entitled “Two Years Later: The Benefits of the Affordable Care Act for Colorado,” “The new health care law forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition.”
The report also maintains, “Thanks to the new health care law, 42,580 people with Medicare in Colorado received a $250 rebate to help cover the cost of their prescription drugs when they hit the donut hole in 2010. In 2011, 39,476 people with Medicare received a 50 percent discount on their covered brand-name prescription drugs when they hit the donut hole. This discount resulted in an average savings of $579 per person, and a total savings of $22,846,993 in Colorado.”
It goes on to add that 973,000 Colorado residents received preventative care without co-payments, 1,432,000 will receive more coverage for their premium dollars, and 1,902,000 have already had lifetime limits on coverage lifted.
While these advances are important, the government’s report makes no mention of those who are still missing from the health care equation. For example, there are 1.5 million medically underserved/underinsured in the state and almost 829,000 without health insurance (16 percent of the state’s population, on par with the national average)—including about 318,000 18-34 year olds and the approximately 300,000 Hispanics.
“In my opinion, that’s way too many people,” said Gretchen Hammer, Executive Director for the Colorado Coalition for the Medically Underserved.
Why is not having health insurance such a big deal? First, consider the cost shifting that occurs when uninsured people need immediate care for conditions that could have been treated in a doctor’s office if caught earlier. The cost shift from uninsured individuals to emergency rooms and hospitals is eventually absorbed by people who have insurance. A 2009 study by Families USA found that uncompensated care costs impose a “hidden tax” on family health coverage of $1,017. Second, consider the conclusion of a December 2009 American Journal of Pubic Health report authored by Dr. Andrew Wilper et al, which stated, “Lack of health insurance is associated with as many as 44,789 deaths per year in the United States, more than those caused by kidney disease.”
According to Statereforum, based on seven criteria for readiness for implementation of the ACA, as of June 1, 2012, Colorado has only completed four of the criteria. Seven states (Mass, Md., Nev., N.Y., Ore., R.I., and Vt.) have completed six out of seven; six others plus the District of Columbia have completed five out of seven (Calif., Conn., D.C., Ky., N.M., Ala., and Hawaii).
On June 15, Peter Lee, director of California’s Health Exchange announced that California was going forward as if the ACA had been upheld. “We [aren't] doing anything in the way of contingency planning because it makes no sense to plan for what seems like an outer bounds of possibility, and rather, we’ve got a big job to do to get ready to cover what will be millions of Californians in 18 months,” Lee said to Capital Public Radio.
By contrast, Colorado’s official Web site for health insurance exchange news only says that it will be open late 2013; although, it does provide an implementation timeline for Colorado’s health insurance exchange. According to the federal government report “Two Years Later,” Colorado has received $18.9 million in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges, which are key provisions of the ACA.
According to healthreform.gov, if the ACA is upheld, on July 1, $90.3 million in federal money will be available in Colorado to help provide coverage for uninsured residents with pre-existing conditions (like myself). The goal of this program is to create a bridge to “2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions.”
The timing of this program’s implementation and the Supreme Court’s decision are too close for coincidence. If the ACA is upheld, then people like me, in Colorado and the other 49 states, will have access to health care through the federal government. Obviously, that $90 million comes from taxpayers that must be balanced against the medical cost shifting mentioned above.
“The information from other places that have gone from no mandate to a mandate—most famously Massachusetts under Romney—has been studied extensively,” said David Langness, Director of Communications for Health Care Reform at Kaiser Permanente. “The studies found that people who come into the health insurance system for the first time have a lot of deferred maintenance. … The expense of their treatment, combined with staffing up with new doctors and nurses and new infrastructure, those costs are most likely to offset any new revenues.”
Costs, constitutionality, benefits, civility, cost shifting, severability, precedence, the role of government… there are dozens of ways to analyze the ACA and none of them bring us any closer to predicting whether or not the Supreme Court uphold the ACA. It’s a massively complex issue, or the court would not have set aside six hours to consider oral arguments, which hasn’t happened in 40 years.
“To give you a point of reference, the Supreme Court only heard 1.5 hours of argument for Bush v. Gore.” said Langness.
From the perspective of an uninsured cancer survivor, what matters most is when will my government get in line will all other major industrial countries and support universal access to quality health care without restrictions or conditions or the threat of it going away.