The US Supreme Court decision on June 25, 2015 to allow premium assistance tax credits to continue through federally-facilitated Exchanges resolves an important underlying question around a major coverage provision in the Affordable Care Act (ACA). The decision removes the threat of 6.4 million people losing federal help to purchase health insurance this year and gives health plans and providers greater certainty heading into the open enrollment period for 2016 (see the June 25, 2015 Health Care Current Special Edition).1
In the days following the Court’s decision, I heard many comment, “Now we are back to status quo.” In my 26 years of health policy experience, I have never considered health care to be “status quo.”
Yes, the ruling in favor of the Administration provided some certainty in the insurance markets regarding the status of Exchanges. But, we are still facing a time of incredible change in health care that is certain to keep us on our toes. Health care providers and plans are experimenting with innovative models to finance and deliver care, not just as a result of the ACA, but on their own accord and to adapt to a changing marketplace and consumer demand. We still have large numbers of uninsured in the US whom providers, plans, and states are seeking to bring into the system through expanded outreach efforts and coverage options.
There also are major regulatory developments coming down the pike beyond 2015 at both the federal and state levels. Now, the Administration will be working to finalize regulations on key provisions of the ACA before President Obama leaves office in January of 2017. For example, regulators will be working on new rules that will set the stage for states who wish to seek “Innovation Waivers” to start reshaping their insurance reforms and mechanisms to expand coverage in 2017. Another provision of the ACA that takes effect in 2017 will open the door to allow large employers (100+ employees) to purchase coverage through health insurance Exchanges previously only open to smaller employers.
Perhaps most notably, the Administration will issue new regulations regarding the excise tax on high-cost employer-sponsored coverage (the so-called “Cadillac” tax), which will take effect in 2018. The imposition of this new tax could drive companies to offer less generous health care benefits to employees. The movement toward less generous employer-sponsored coverage could in turn prompt health care plans and providers to re-evaluate their products, payer mix, and services.
The next presidential election is widely considered to be the most significant upcoming event for health care in the next 18 months. Regardless of who is elected on November 8, 2016, it will mark the first time someone other than President Obama will have stewardship over the ACA and responsibility for developing regulations to implement the law. A new Administration might revisit some of these regulations, raising prospects for health care providers, plans, and other stakeholders to re-open certain rules and put forward alternative approaches for consideration.
Beyond the ACA, the next Administration will bear considerable influence over the implementation of the recently enacted Medicare physician payment law, which aims to more closely align Medicare reimbursements with health care quality and outcomes (see the April 14, 2015 Health Care Current). The next Administration largely will determine how new incentive payments for providers in traditional care delivery models will be developed and refined over time.
The Supreme Court steadied the ground beneath our feet. But health care is anything but “status quo” and we are a far cry from standing still in one place. We must continue to look ahead to the changing health care landscape, plot our course and travel full speed ahead.
Source: 1Centers for Medicare & Medicaid Services, “March 31, 2015 Effectuated Enrollment Snapshot,” June 2, 2015.