Moving the Nation’s Health Care Ahead—With or Without the Affordable Care Act

By Guest Blogger

This blog was written by Claudia Page, Co-Director, Social Interest Solutions.

As we wait for the Supreme Court’s final ruling on the constitutionality of the Affordable Care Act, we must be mindful of the law’s original intent: modernizing the country’s health and human services infrastructure, improving operational efficiencies, enhancing overall consumer experiences, and increasing coverage.

Regardless of the court’s decision, the health care law has already planted seeds that will forever alter the health and well-being of many of the nation’s residents. Even if the individual mandate is struck down, the entire bill is rescinded, or anything in between, the federal government and states can and should continue to overhaul how health benefits are obtained and delivered. The nation must continue to improve in the following key areas, regardless of the Supreme Court ruling:

Eligibility and Enrollment

Many states’ Departments of Motor Vehicles have recently taken steps to put most of their business online in order to enable consumers to register their vehicle, change their address, pay parking tickets, and more, all in real time. The Centers for Medicare & Medicaid Services (CMS) should strive to modernize eligibility and enrollment systems to make enrolling in public and private health programs as easy as renewing a license—with or without the Affordable Care Act as we know it today.

Most people will apply for and enroll in public, subsidized, or private coverage online. As much as possible, verifications should be done electronically in real time by matching data against federal and state databases, rather than making consumers provide hardcopy documentation for pay stubs, birth certificates, etc. Renewals should be automated, thereby replacing the multi-step, time-consuming, and inefficient renewal processes in place today. This will ensure continued coverage for eligible consumers. Options for supporting real-time eligibility and enrollment have already been identified by states working to meet these requirements in the Affordable Care Act, and regardless of the Supreme Court’s decision, these improvements should be pursued.

While the Affordable Care Act defines eligibility and enrollment requirements for Medicaid and the Children’s Health Insurance Program (CHIP), eligibility and enrollment policies for other benefit programs are mentioned, but not specifically addressed by the law. Programs such as Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps), Temporary Assistance to Needy Families (TANF), and a variety of other federal, state, and local programs  should also be considered when revamping eligibility and enrollment systems. It only makes sense for states to consider adopting the modernized eligibility and enrollment policies and systems set forth in the Affordable Care Act to support an even wider array of benefit programs. Modernizing and improving the enrollment process for these programs will save consumers and state workers time while providing more accuracy and efficiency. These kinds of improvements should also be pursued regardless of the court’s decisions.

Medicaid Expansion  

The law’s Medicaid expansion extends Medicaid coverage to all adults under the age of 65 with incomes at or below 138 percent of the federal poverty level, which is a big expansion for many states. Starting in 2014, single adults earning up to $15,415 or families of four with incomes up to $31,809 across the nation will be eligible for Medicaid. That translates to roughly 15 million low-income Americans. This expansion will sharply reduce the number of people without health insurance and decrease the otherwise uncompensated costs for care for the uninsured. The Medicaid expansion will also help protect residents against preventable illnesses and will likely result in a healthier workforce.

If the Supreme Court rules that only the individual mandate is unconstitutional and leaves the rest of the Affordable Care Act standing, states should harness the federal funding that will remain available as part of the law. It only makes sense to continue to improve and replace outdated IT systems and to implement innovative Medicaid reform measures.

Health Insurance Exchanges

The purpose of an exchange is to provide consumers and small businesses a single point of entry to obtain public, subsidized, or private coverage. States can choose to establish their own exchange, use a federal insurance exchange, or enter into a partnership with CMS. Even if the individual mandate is struck down, states will still need to set up exchanges. There is great benefit in providing consumers the opportunity to compare standardized offers from competing insurers so they can make the best choices based on their needs.

In addition to establishing exchanges, states should offer insurance affordability programs, including tax credits and cost-sharing reductions, even if the individual mandate is struck. These critically important components of the Affordable Care Act will assist people who make too much to qualify for Medicaid but still struggle to afford health insurance. By using the tax credits and cost-sharing reductions to offset the cost of monthly insurance premiums, coverage will be more affordable for lower-income people. Lowering out-of-pocket costs can make insurance much more appealing, and will therefore offer an incentive to purchase health coverage. If more people have insurance, overall risk will be decreased, and thereby overall costs will go down as well. This is a win-win strategy, and we should remember that even if the individual mandate is struck from the law, people can still benefit from tax credits and reduced cost sharing to make coverage more affordable.

Win or Lose, We Could Still Win

As we await the final verdict from the Supreme Court, we must remember the core tenets of the Affordable Care Act: modernizing eligibility and enrollment systems; expanding coverage for those in need; and making insurance more affordable, understandable, and accessible for millions of uninsured Americans. With or without the Affordable Care Act, these goals are vitally important to the health and well-being of all Americans. With so much at stake, these changes can (and must) happen—with or without the Affordable Care Act.


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