Our Health Policy Matters

The Supreme Court decision on the constitutionality of the Affordable Care Act is finally in. Before it was announced, most people seemed to think that the individual mandate would be overturned.  It did not play out that way.  The individual mandate was upheld – not under the Commerce Clause of the Constitution, but as a tax.  Justice Roberts proved to be the swing vote. Also left intact are the expansions of Medicaid eligibility and, as a result, the entire law, with all of its consumer protections. However, there is a major caveat here. States can opt out of the expansion of the Medicaid program without jeopardizing the rest of its Medicaid funding.  In other words, the Court is allowing a state to refuse to expand Medicaid eligibility to 133% of poverty and to refuse to cover all of the ACA-mandated basic benefits in its program.  If it does, it will only have to give up the new federal money that pays for these benefits. The consequen...

The Supreme Court decision on the constitutionality of the Affordable Care Act is finally in. Before it was announced, most people seemed to think that the individual mandate would be overturned.  It did not play out that way.  The individual mandate was upheld – not under the Commerce Clause of the Constitution, but as a tax.  Justice Roberts proved to be the swing vote. Also left intact are the expansions of Medicaid eligibility and, as a result, the entire law, with all of its consumer protections. However, there is a major caveat here. States can opt out of the expansion of the Medicaid program without jeopardizing the rest of its Medicaid funding.  In other words, the Court is allowing a state to refuse to expand Medicaid eligibility to 133% of poverty and to refuse to cover all of the ACA-mandated basic benefits in its program.  If it does, it will only have to give up the new federal money that pays for these benefits. The consequen...

Here’s why you don’t need to be holding your breath while awaiting the announcement of the Supreme Court’s decision on the Affordable Care Act. Its immediate impact on you may be a whole lot less than you think. And here’s why you should be holding your breath. How the Court rules could ultimately determine whether private health insurance or public health insurance is the way we finance health care in the future. The reason is this.  ACA expanded both the role of private insurance and public insurance in providing healthcare coverage in the future.  It added a projected 13 million people to the private insurance rolls and 17 million to Medicaid.  The 13 million were added to private insurance primarily through a mandate that individuals who can afford it buy insurance.  The 17 million were added to Medicaid through a mandate that the states expand the Medicaid-eligible population. The Supreme Court was asked to rule on the constitutionali...

Here’s why you don’t need to be holding your breath while awaiting the announcement of the Supreme Court’s decision on the Affordable Care Act. Its immediate impact on you may be a whole lot less than you think. And here’s why you should be holding your breath. How the Court rules could ultimately determine whether private health insurance or public health insurance is the way we finance health care in the future. The reason is this.  ACA expanded both the role of private insurance and public insurance in providing healthcare coverage in the future.  It added a projected 13 million people to the private insurance rolls and 17 million to Medicaid.  The 13 million were added to private insurance primarily through a mandate that individuals who can afford it buy insurance.  The 17 million were added to Medicaid through a mandate that the states expand the Medicaid-eligible population. The Supreme Court was asked to rule on the constitutionali...

Special Note:  The Supreme Court's decision on the Affordable Care Act is expected soon, and when it comes there will be implications for us all.  The OHPM publication schedule may change that week to provide timely analysis, and may publish more than once. I remember how surprised I was the time I was told that a member of my family had hit his lifetime limits on some of his health insurance benefits.  He had about sixty more years of life expectancy!  I knew then that capping health insurance benefits could be a cruel and bankrupting blow to those who need them the most. That’s why Monday’s announcement by UnitedHealthcare that, no matter what the Supreme Court decides, it will keep in place some of the new  Affordable Care Act-mandated consumer protections was good news. As reported in Kaiser Health News , the nation’s largest health insurer said that it would keep free preventive services, allow children up to age 26 to stay on parents’ plans...

Special Note:  The Supreme Court's decision on the Affordable Care Act is expected soon, and when it comes there will be implications for us all.  The OHPM publication schedule may change that week to provide timely analysis, and may publish more than once. I remember how surprised I was the time I was told that a member of my family had hit his lifetime limits on some of his health insurance benefits.  He had about sixty more years of life expectancy!  I knew then that capping health insurance benefits could be a cruel and bankrupting blow to those who need them the most. That’s why Monday’s announcement by UnitedHealthcare that, no matter what the Supreme Court decides, it will keep in place some of the new  Affordable Care Act-mandated consumer protections was good news. As reported in Kaiser Health News , the nation’s largest health insurer said that it would keep free preventive services, allow children up to age 26 to stay on parents’ plans...

Opponents of the Affordable Care Act (ACA) are now looking to the Supreme Court to overturn the 2010 law before time runs out on them. After ACA became law eighteen months ago, they were optimistic that they could beat back several of its key provisions.   These included the minimum medical loss ratios, the expansion of Medicaid, the health insurance exchanges, and the individual mandate. A brief review of the current status of each shows why the individual mandate is the last one standing.   But as the arguments for and against it have crystallized in the Courts, they show how the Supreme Court could open a Pandora’s Box best left closed.   Minimum loss ratios ACA mandates that all private insurance plans will have to pay at least 80 to 85 cents in benefits for every premium dollar collected, or rebate the difference to policy holders beginning in 2012.   Opponents argued that many existing plans would be forced out of the market because of high ad...

Opponents of the Affordable Care Act (ACA) are now looking to the Supreme Court to overturn the 2010 law before time runs out on them. After ACA became law eighteen months ago, they were optimistic that they could beat back several of its key provisions.   These included the minimum medical loss ratios, the expansion of Medicaid, the health insurance exchanges, and the individual mandate. A brief review of the current status of each shows why the individual mandate is the last one standing.   But as the arguments for and against it have crystallized in the Courts, they show how the Supreme Court could open a Pandora’s Box best left closed.   Minimum loss ratios ACA mandates that all private insurance plans will have to pay at least 80 to 85 cents in benefits for every premium dollar collected, or rebate the difference to policy holders beginning in 2012.   Opponents argued that many existing plans would be forced out of the market because of high ad...