What with the healthcare reform bill’s future now resting in the Supreme Court’s hands, some states sit watching from the sidelines assuming the law will be overturned. Others, meanwhile, continue moving cautiously to the end-zone putting in place policies, operations and systems required to meet the ACA’s 2014 health insurance exchange (HIX) deadline.
Regardless of the final ruling, the healthcare law has already changed the conversation and the dynamics at the highest levels of Federal and state government by planting seeds for modernizing the country’s health and human services infrastructure, improving operational efficiencies, and enhancing overall consumer experiences.
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If the individual mandate is struck down, the entire bill is rescinded, or any outcome in between, the Federal government and states can – and should – continue to revamp how benefits are accessed and delivered. While Federal financing will still be required, it is essential for the nation to continue to promote improvements in three key areas, no matter how the Supreme Court rules. Those are:
1. Eligibility and Enrollment: The ACA vision for enrolling in coverage assumes that while some people will still need assistance applying for coverage, the vast majority will enroll in public, subsidized, and private coverage online, by themselves. Real-time is the new vision: Verifications will, as much as possible, be done electronically by matching data against Federal and state databases, rather than making consumers provide hard copy documentation for pay stubs, birth certificates, etc., as they do now. Renewals will be automated – thereby replacing the multi-step, often time-consuming and inefficient renewal processes in place today – ensuring continued coverage for eligible consumers. States working to meet these requirements of the ACA have already identified options for supporting real-time eligibility and enrollment.
Just as the Department of Motor Vehicles (DMV) years ago moved most of its business on-line to enable consumers to register vehicles, change addresses, pay parking tickets and more, all in real-time, the Center for Medicare & Medicaid Services (CMS) should strive to modernize eligibility and enrollment systems to make enrolling in public and private health programs as easy as renewing a license.
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Furthermore, while the ACA defines eligibility and enrollment requirements for Medicaid and the Child Health Insurance Program (CHIP), eligibility and enrollment policies for other benefit programs such as Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps), Temporary Assistance to Needy Families (TANF) and a variety of other Federal, state and local programs (e.g., LIHEAP, EITC and Unemployment Benefits) are mentioned, but not specifically addressed in the law. States should consider adopting the modernized eligibility and enrollment policies and systems set forth in the ACA to support an even wider array of benefit programs. Providing a far more efficient and effective enrollment process will save consumers and state workers time and provide more accuracy than current processes and systems.
2. Medicaid Expansion: A provision of the law, known as Medicaid Expansion, makes all adults under the age of 65 with incomes at or below 138 percent of the Federal Poverty Level (FPL) eligible for Medicaid. This means a single adult earning up to $14,404 or a family of four with income up to $29,327 will now be eligible for Medicaid. Prior to this ACA provision, low-income parents and childless adults were ineligible in most states. Now roughly 15 million low-income Americans will be able to enroll in Medicaid, thereby sharply reducing the number of people without health insurance and ultimately leading to a decline in care costs for the uninsured. Medicaid Expansion will also help protect residents against preventable illnesses and likely result in a healthier workforce.
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If the Supreme Court rules that the individual mandate is the only unconstitutional element of the law – leaving the rest of the ACA standing, including Medicaid Expansion – states should harness the financing that will presumably remain available as part of the ACA to continue implementing Medicaid reform measures, as well as improving and replacing outdated, siloed IT systems that today inefficiently support Medicaid.
3. Health Insurance Exchanges: At the core of the Affordable Care Act is the mandate for states to establish health insurance exchanges, utilize the federal insurance exchange or enter into a partnership with CMS to stand up an exchange.
The purpose of an Exchange is to provide consumers and small businesses a single point of entry to obtain health coverage or buy affordable health insurance coverage. Health insurance exchanges could certainly function without the mandate in the event it is struck. Indeed, there is great benefit in providing consumers the opportunity to select among competing insurers offering standardized products so they can easily compare offerings and make smart choices.
A critically important component of the ACA is the offer of insurance affordability programs including Advanced Premium Tax Credits (APTC) and Cost Sharing Reductions (CSRs), as well as other incentives that will likely remain in place if the Supreme Court strikes the individual mandate only. These programs will assist people who earn too much money to qualify for Medicaid, but are still lower-income households struggling to afford health insurance. By using the APTC and CSR to offset the cost of monthly insurance premiums, coverage will now be more affordable for this population.
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Lowering out-of-pocket costs can make a big difference and, hopefully, will offer a real incentive for these consumers to purchase health insurance. Increasing the number of people who have insurance helps to lower the overall risk pool and, it follows, the overall costs. Legislation-driven or otherwise, this is a win-win strategy and states should not abandon such programs in the event the mandate is struck from the ACA.
ACA: win or lose – patients still stand to win
Let there be no doubt, the ACA ruling is on everyone’s mind. But, win or lose, the core tenets of the ACA – modernizing eligibility and enrollment systems, expanding coverage for those in need, making insurance more affordable, understandable and accessible for millions of uninsured Americans – are issues the nation must continue to address.
Our national fiscal health and the well-being of many residents depend upon these types of reforms. Indeed, with so much at stake, changes can, and must, happen with or without the ACA as we know it today.
For more of our politics coverage, visit Political Malpractice: Healthcare in the 2012 Election.
