Christen Linke Young explains what would happen if the U.S. Supreme Court strikes down the Affordable Care Act (aka ACA or Obamacare): chaos.
The Supreme Court will hear oral arguments about the future of ACA on November 10. The Republican-controlled Senate is rushing through the confirmation vote on Judge Amy Coney Barrett so that she can be seated before the election. Her writings indicate that she will vote to overturn the ACA.
Young writes:
If the Court strikes down the ACA in its entirety, 20 million people would lose health insurance, a variety of protections for people with pre-existing conditions would be eliminated, and an extensive set of policies affecting Medicare, Medicaid, prescriptions drugs, and other parts of the health care system would be reversed. Significant attention has been paid to the policy changes that elimination of the ACA would bring when fully implemented, but there has been more limited analysis of how health care stakeholders would cope with the sudden elimination of myriad ACA provisions in the short-term. This piece considers some of the major changes (outside the private insurance market) that would follow in the wake of Supreme Court decision eliminating the ACA and concludes that implementation is likely to be quite chaotic. While Congress could in theory ameliorate some of this chaos by quickly enacting legislation, the political trajectory of the ACA to-date does little to inspire confidence that such action would be forthcoming.
To begin with, she writes, there would be a “payment paralysis” in Medicare.
The ACA made many changes to Medicare, generally designed to reduce unnecessary spending and improve quality of care. Those new rules are fully “baked in” to Medicare’s policies for making $800 billion in annual payments. In many instances turning off these ACA provisions would not be straightforward and would require the federal government to conduct a careful legal analysis to understand what the statute requires once the ACA provision is removed. This undertaking would be particularly complex in instances where Congress has passed legislation since 2010 that either amended or presupposed the existence of an ACA provision. It would often raise novel questions of statutory interpretation, which would likely spur additional litigation given the financial stakes involved. These problems would play out in a range of concrete settings:
- Health care providers and health insurers would face tremendous uncertainty in payments. The ACA made changes to how traditional Medicare pays virtually every category of health care provider, including hospitals, physicians, skilled nursing facilities, and many others, as well as major changes to how Medicare pays private Medicare Advantage plans. Reverting Medicare’s payment rules to a pre-ACA state would require revisiting dozens or even hundreds of policy choices the agency has made since 2010, which would likely take months or years. It might be particularly difficult to determine how Medicare should make payments to physicians since the 2015 Medicare Access and CHIP Reauthorization Act made significant changes to how Medicare pays physicians presupposed the existence of a number of ACA policies. It is unclear how CMS would make payments to providers and insurers while this process was ongoing, as it would face a choice between failing to make timely payments or making payments inconsistent with the law.
- Re-opening the Medicare “donut hole” would be chaotic for insurance companies, drug manufacturers, pharmacies – and consumers. The ACA closed the Medicare Part D “donut hole.” In doing so, it required drug manufacturers to offer discounts for certain prescriptions to plans and changed the cost-sharing plans could charge enrollees. In the aftermath of a decision to eliminate the ACA, those manufacturer discounts might immediately end, and it would be unclear what beneficiaries in a newly reopened donut hole should be charged when filling prescriptions. Nor would it be clear how to interpret many existing contracts that assumed ACA policy was in effect. The agency would also need to determine how to interpret a 2018 law that made modifications to this ACA provision, which could generate additional litigation.
- Health care systems that have invested in Accountable Care Organizations would face significant additional uncertainty.Accountable Care Organizations (ACOs) deliver care for about a quarter of Medicare beneficiaries, but all existing ACO payment models derive from the ACA. ACOs have made significant investments in redesigning care on the assumption that they could receive incentive payments if they met certain standards for the quality and efficiency of the care they delivered. The federal government might attempt to resurrect some aspects of ACO models under non-ACA authorities, but its success is likely to be limited, and the scope of any new program will be quite uncertain as policy is developed, likely for years. There would also be considerable uncertainty about how ACOs that had already signed contracts with CMS would be treated if the legal authority undergirding those agreements vanished.
- Medicare’s authority for a variety of other demonstrations and quality improvement projects would be eliminated, disrupting all the payment streams impacted by those projects. As just one example, the Innovation Center’s Comprehensive Primary Care Initiative (one of about 50 active Innovation Center projects), has more than 3000 participating providersacross the country. As with ACO payment models, federal agencies might be able to resurrect portions of these initiatives using non-ACA authorities but doing so would be complex and time consuming. In the meantime, many of the payment changes bound up in these complex projects would need to be undone, impacting a wide variety of types of health care providers in uncertain ways.
- The Medicare Hospital Insurance Trust Fund would face insolvency far sooner, and there would be significant uncertainty about when. Elimination of the ACA would eliminate taxes on high income household’s investment earnings that support the Medicare Hospital Insurance Trust Fund and require Medicare to pay more to insurance companies and providers, accelerating the insolvency of the trust fund, already projected for 2024. Some of these changes could also be retroactive, with insurance companies, providers, and high-income taxpayers seeking compensation (through the agencies, or through the courts) for past years. Therefore, the magnitude of the near-term impact on the Trust Fund is difficult to predict and might be affected by subsequent litigation.
And that is only the beginning of the problems that would be caused by tossing out a government health insurance plan that currently protects 20 million people. Read the whole essay.
Truly sickening and nauseating. What is it with the GOP, why do they hate the people so much that they would deny them health care?! Meanwhile in the rest of the civilized wealthy democracies, all the people are covered with a national health care system.
It seems like we keep paying taxes, but the main beneficiaries are corporations and billionaires. Eliminating the ACA would have far reaching repercussions on Medicare and health care for other vulnerable groups. It would be a gigantic snowball of destruction.. We should also remember that if Trump wins, it will mean the defunding of Medicare and Social Security. Maybe herd immunity is the Republican dystopian plan for dealing with the elderly.
What wealthy democracies have affordable health care? 😐
Universal health care: Canada, Taiwan, South Korea, Japan, Israel, the UK, Germany, Italy, France, Norway, Sweden, Denmark, Finland, Australia, New Zealand, Holland, Switzerland, Austria, Belgium, etc. They have free health care at the point of entry and nobody goes bankrupt from medical or drug costs. Everyone is covered.
Thank you, Jersey Joe. 🙂
Not all of the countries listed are democracies though. 😐
All of those countries listed are free democratic nation-states. They have free elections, they elect their representatives, MPs or whatever. They have a different version of democracy (parliamentary) than the USA but they are nonetheless democracies.
Thanks again, Jersey Joe. 🙂
And this whole mess exists because health care is fully privatized…..ushered in with the help of both sides of the aisle. Health care has become a business to expand wealth at the top (Big Pharma, Insurance etc) instead of being a service to the people. This all started in the 80’s…no one wanted to listen to the Dr’s and RN’s about the impending doom. If the ACA is overturned, big business will still bring in top dollar while millions will suffer and/or die while millions more will go broke trying to pay to stay alive. I’m a believer in Medicare for All, but at least the ACA provided benefits to some. This is just wrong!
Trump is a VERY SICK person. Trump hates ObamaCare because he is so jealous of Obama.
Trump will do anything to DISS Obama and make himself look good, but he can’t because there is NOTHING “good and of value” when it comes to DUMP.
Dump would sell his mother to make himself look good.
I will never forget that Dump got rid of Obama’a Pandemic Team housed in the White House and HERE WE ARE … #1 re: Covid-19 infections in the world. Guess Dump SHOWED the world that he is indeed “MORON-in-Chief.”
I will also remember … Dump hung around and partied with that horrible evil man, Epstein. I am convinced Epstein did not commit suicide, but was snuffed. The evidence does not hang together.
Trump is EVIL to the MAX and the worst potus ever.
When dump leaves office and not soon enough, a BIG CLEANSE will be needed in the wh.
ABSOLUTELY, Yvonne. That’s one of the reasons I cringe when I hear it–perhaps if everyone just keeps calling it the ACA, it45 will forget the other name, & let up.
Unfortunately, not gonna happen.
Notice also the television programs crammed full of ads for seniors to sign on to health care plans which promise the moon in “free services,” and have a graphic design to suggest these are real “Medicare, or “Medicare advantage” plans if you qualify.
In the meantime current Medicare recipients, I am among these, have long since received a thick booklet with a list of Medicare plans actually available. These are listed by metro areas in my state. My booklet offers two choices of “plans,” an indication of the cost, and a phone number to call for more information.
I dread the prospect of being unable to continue being cared for by my MDs. I am also concerned about their own survival in the face of more and more “accountability measures” with warnings clearly posted on their computers, and color coded on data dashboards.
If the money used to fund the administrative and legal bureaucracy to provide “choice” in medical care (Medicare and regular insurance) were shifted to actual medical care and support for individuals to access it (transportation, home care, nursing assistance), it would likely cost the same and actually benefit people. Not to mention eliminate the confusion and stress of having to “choose.”
And thank you, Diane for posting this article. It is a very helpful source to explain the consequences of gutting the ACA.
Nailed it, Greg!
Make no mistake. The lure of all the additional benefits in Medicare Advantage Plans is a way to privatize Medicare. A serious illness could be devastating in these plans. They only make any sense for younger, healthier seniors. Medicare also allows seniors to transfer back into Medicare during the enrollment period, which I image, many seriously ill seniors do. Once again, these plans are a way to attract low cost seniors, just like charter schools do with students, while the seriously ill wind up on Medicare and shift the costs to the government.
cx: ,which I imagine,
Our MAP is supposed to be the best, but little-by-little they have been cutting out benefits (but–in these days–are touting ones they know we won’t use: Silver Sneakers, e.g.–what senior in his/her/their right mind is going to go to a gym these days?! Not to mention,in IL, at least, they’ll soon all be closed, given our rising covid #s & watchful Gov. {thank you, J.B.!} & the IDPH experts}).
Anyway, my husband was steaming over a recent dental exam–used to be,but now–suddenly–not paid for, & wants to look at other MAPS.
&, of course, these plans promise the sun & the moon, but are impossible to wade through (like legislative bills, which look good, but always have something evil thrown in, & are 100s & 100s of pages).
If the Supremes yank the medical insurance of millions of Americans, Congress should yank the insurance of the Supremes and their families.
It would only be fitting.
Any money that Brett K has to spend on insurance would be money that he could not put toward beer.
And that would certainly make him sit up at the bar and take note (pun intended)
And every dollar Amy Crony Barrett had to spend on insurance would be a dollar she could not give to right wing hate groups sponsoring discrimination against LGBT’s and others.
Politicians should pay for their own healthcare. 😐
Members of Congress get gold-plated health insurance.
So do long-serving and high level federal officials and members of the military. Their pensions and benefits are never at risk as those of workers in the private sector are. And the VA healthcare system, despite occasional glitches, is generally considered to be superb. It’s modeled on European-style healthcare and the arguably the most “socialist” entity in the federal government. Love bringing that up to right winger vets who ignorantly crow about the evils of socialism. I hope it occasionally gets them so worked up that they need to seek medical care in the “un-American” VA!
There is a full-court press now to privatize the VA health insurance.
If the VA becomes privatized, it’ll snap your neck to see how quickly veterans become vocal socialists!
Many people are still struggling with Healthcare costs with ACA. The insurance companies are doing quite well though. The only alternative is universal healthcare. Maybe the Supreme court will force the neoliberal democrats to consider it if Biden wins?