Last week's drama at the Supreme Court and most of the media coverage that followed omitted crucial information:' how a decision either upholding or junking the Affordable Care Act (ACA) will affect ordinary Americans.' Because the health reform law is not well understood by most people, it's worth recapping what might happen.
Insurance Coverage Mandate
Most of the 160 million Americans who have health insurance from their employers won't be affected directly by the Supreme Court's ruling either way.' Most will continue to get job-based coverage.
A mandate for everyone to have health insurance is at the center of the Supreme Court case. If the individual mandate is upheld, every state will implement 'exchanges' where people without health coverage will be able to shop for insurance.' However, those with employer-sponsored coverage will not be eligible to purchase insurance from the exchange unless their share of the premium for their employer insurance is greater than 9.5 percent of their gross income.' ' If employer coverage is skimpy or too expensive, they'and their family members'are stuck.
If the Supreme Court upholds the mandate, then people who do not have coverage either from government programs or from their employers will have to buy it.' Those with incomes less than about $92,000 (about $45,000 for individuals) will receive subsidies that will help cover the cost of a policy.' Those with lower incomes will receive more help.' If the mandate is struck down, people without coverage are in the same fix they are now.' They will still be at the mercy of the individual insurance market where premiums are very high, and insurers often reject those with preexisting conditions.
Whether young adults will still be able to obtain coverage under their parent's insurance until they turn 26 will depend on whether the court strikes down the entire law or just the mandate.' ' The requirement to cover young adults is already in effect, giving coverage to some 2.5 million young adults.' If that provision goes, then this group will be in the same position they were in before the law was passed.' Some carriers might allow them to stay on their parents' insurance; others might not.' In that case, they, too, will have to shop in the individual market.
More on Those Exchanges
If the mandate stays, states will set up shopping exchanges where insurance companies would sell their policies in a kind of insurance bazaar.' Policies will have to meet minimum standards, but states will have a lot of discretion about what the basic plan will cover.' Consumers will be able to choose from among four types of policies:' bronze policies will be the cheapest and will cover only 60 percent of a policyholder's medical costs; the silver policy will cover 70 percent; a gold policy 80 percent; and the most expensive platinum policy will cover 90 percent and offer Cadillac coverage for a price, of course.' ' ' If the mandate goes, some states may operate their own exchanges similar to what Massachusetts does.' Those who will have to buy health insurance in the individual market and even those with employer coverage will find policies that will cover varying amounts of their medical expenses.' They won't be called bronze, silver, gold, and platinum, but they will be similar.
Rising Health Care Costs
The big pocketbook issue for consumers will be whether there will be a slow down in the increase of health care costs.' Those ever-rising prices are responsible for a large chunk of the premiums everyone pays, and they also make it tough to cover those high deductibles and coinsurance the newer models of skimpy coverage require.
The Affordable Care Act contains a number of measures designed to provide better care that will ultimately result in lower prices, or so the designers of these provisions have hoped.' These include so-called medical homes and accountable care organizations (ACOs), which are supposed to better manage patients' conditions.
The law also calls for rewarding hospitals with larger Medicare reimbursements if they give better care.' ' Some of these efforts will continue regardless of a Supreme Court decision to overturn the ACA. But it is unclear whether the ACA provisions can lower costs or improve care.' A study published last week in the New England Journal of Medicine ' found that paying hospitals to improve their quality of care did not appear to help patients live longer.' The health reform law calls for bonus payments to hospitals that show improvement.
No one knows yet what the Supreme Court will decide, but either way its decision will affect everyone's pocketbook.