The dust is starting to settle and a pall has been lifted from over providers' heads, following yesterday's historic Supreme Court ruling on King v. Burwell. Now, players in the health care industry are determining the next steps.
With Obamacare surviving this latest fright, business groups and other stakeholders hope that Congress may finally turn its attention toward revising the legislation to make it stronger. Timothy Jost, an Affordable Care Act expert and professor at the Washington and Lee University School of Law, believes the decisive 6-3 vote, and the fact that it was written by conservative Chief Justice John Roberts, provides extra fuel to do so.
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"It indicates the Supreme Court did not find this a terribly hard case, and they're sending a clear signal that it's time to end all of this foolish litigation and get on with implementing the statute," Jost said.
He believes it's possible a Republican president and filibuster-proof Senate could put the kibosh on the ACA in 2016, but it's starting to become such an ingrained part of the health care system that it'll be difficult to undo. "It's like killing the interstate highway system," he added.
In a blog post Tuesday, Jost laid out various health reform-related cases currently making their way through the courts, many of which are starting to get tossed out. With King v. Burwell in the rearview mirror, he said, lower courts likely will be influenced and less receptive to such challenges.
Meanwhile, trade groups representing employers — such as the National Retail Federation and American Benefits Council — urged Congress to "seize the opportunity" and address what they say are shortcomings in the law. Those include repealing the employer mandate and Cadillac tax on pricier plans, reforming reporting requirements, and upping the 30-hour work week standard for eligibility to 40 hours.
Neil Trautwein, vice president for health care policy with NRF, said there are multiple bills in the pipeline that politicians put on hold while King v. Burwell made its way through the courts. He is hopeful that Congress will put partisan rancor aside following Thursday's ruling.
"Anything we can do to lower the cost of health care and make it easier for our members to comply with a very complex law, we think, will improve public reaction to the law, and make it easier for us all to live with it," he said. "Nothing is easy in Washington, but I do think and hope that, with this decision, we can see a path forward to moving on many of these priorities."
On the affordability front, Paul Keckley, managing director in the Navigant Healthcare practice, believes that insurers who stood to lose customers and dollars had the decision gone the other way, "dodged an immediate bullet." However, they face a tough next few months. The individual insurance market is risky and challenging, and rate filings are pricing insurance plans with sizable hikes. He believes attention now will turn to those increases and ongoing consolidation in the market, such as Anthem's move to takeover Cigna.
"It'll be interesting to see how the insurance companies now communicate about this to, not just the 6.4 million who would have been affected, but doctors and hospitals about what it means and what to look for," Keckley said. "Because there's still a lot of anxiety out there in the market and the rate filings suggest that health insurers are going to be all over the place in their requested increases. I think that's one to watch."
At the local level, some believe the lifted cloud may lead some states to take a closer look at Medicaid expansion going forward. Trish Riley, executive director of the National Academy for State Health Policy, said they're convening state policy leaders — insurers, governors' offices, exchanges, Medicaid agencies, etc. — from around the country in early July to talk about the next steps for states, and opportunities to take on health care's bigger challenges now that the subsidies are secure. A summary from the discussion will follow later in the month.
John Ayanian, M.D., director of the Institute for Healthcare Policy and Innovation at the University of Michigan, says maintaining affordability for consumers and flexibility for states will be key to the law's success moving forward. In his own state, the Republican legislature and governor agreed to expand Medicaid — with provisions such as greater cost sharing, financial incentives for healthy behaviors and health savings accounts — to make the expansion more palatable to both sides of the aisle. Similar leniency has been granted by the feds elsewhere, with waivers granted to Arkansas, Indiana and Pennsylvania, he pointed out.
"We may see opportunities for more flexibility in the design of Medicaid across states that could entice more to participate in the expansion," Ayanian said. "The ruling provides more stability for the law overall, and the investments made by insurers and providers in extending coverage and access to care to those newly enrolled can now be sustained. The goal now is to make sure insurance is as affordable as possible, and strive to be sure that it gives people access to good, quality care."