Last Thursday, 6.4 million consumers could breathe a sigh of relief when the Supreme Court, led by Chief Justice John Roberts in a 6-3 ruling, affirmed that all parts of the Affordable Care Act remain the law of the land. With this latest attack on the health care law resolved, we have reached a turning point for health care reform.
King v. Burwell challenged whether tax credits (subsidies) that reduce the cost of health insurance premiums for lower-and moderate-income consumers could be available across the country or just in states that established their own health insurance marketplaces (exchanges). The Court has now ruled in favor of the government’s argument that both the text and intent of the law was to allow tax credits in every state. With this decision, we have hopefully reached an end to the legal wrangling designed to dismantle the law’s protections for consumers. Justice Roberts made clear that the ACA can now only be taken away by an act of Congress signed by the President, a scenario that appears unlikely.
The ACA has now survived more than 50 failed attempts by Congress to repeal all or part of the law and two high profile Supreme Court cases. The futility of these attempts to undo the law, as well as the increasing number of Americans benefitting from the law each day, should lead to a decline in the political attacks on the law. Policymakers should move on to continued implementation of the ACA and achieving further gains in improving our health care system.
There are a few key areas in particular that Families USA considers important next steps. They include:
- Closing the Medicaid coverage gap. 21 states have still not expanded the Medicaid program as the ACA envisions. We must work to ensure the 3.7 million people who would benefit from expansion are not left behind.
- Making health care even more affordable. While the ACA made great progress, there is still work to do to improve access to care for people with marketplace coverage. Work is necessary to ensure that out-of-pocket costs, like deductibles, are affordable and that enrollees aren’t forced to go out-of-network and face high bills due to inadequate provider networks. In addition, Congressional action is needed to eliminate the “family glitch” that prevents the families of some workers from accessing premium tax credits.
- Addressing health care disparities. Communities of color disproportionately face barriers to high-quality, affordable health care, and some immigrant groups are locked out of the system entirely. We must work to ensure all people have affordable access to high-quality care, translation services, and culturally competent providers and insurers.
- Transforming the health care system. We spend more money on health care than most other industrialized nations, yet do not always get better results. Aligning provider payments with the right incentives, better engaging consumers with their care, designing health insurance benefits that promote high-value care, and ensuring treatments are based on strong evidence will go a long way to improving care quality and reducing health care costs in the United States.
- Maximizing Enrollment in the Marketplaces. Many people are eligible for coverage and for financial assistance but do not know it. More work is needed to enroll the remaining uninsured, especially harder-to-reach populations.
For the millions of Americans whose health insurance hung in the balance, King v. Burwell represented a moment of fear. Celia Maluf is one such consumer. The sixty-year-old Miami woman works three part-time jobs but cannot afford health insurance without the subsidies. For months she worried that the Supreme Court would take away her health care. When the decision finally came down, she expressed a collective sigh of relief and declared: the “nightmare is over.” Indeed it is. Now we will move forward, away from attacks on health reform, and towards achieving high-quality, comprehensive, and affordable health care for all Americans.
Ben D’Avanzo is special projects manager and Claire McAndrew is private insurance program director for Families USA.