Once the U.S. Supreme rules against the plaintiffs in King v. Burwell this June, it will be high time for the supporters of the Affordable Care Act (ACA) to foreclose against further actions to kill the landmark legislation.
For those of you shaking your heads against my presumptuousness, I have yet to hear a rational human being, either Republican or Democrat, who believes that the high court will invalidate the tax subsidies that are currently allowing 7.5 million Americans to purchase affordable health insurance.
In the high-powered and often boisterous email listserve I participate in that is operated by Seattle healthcare attorney and entrepreneur Peter Grant, some healthcare leaders have said they're embarrassed as Americans that the case got as far as it did. And given that hospital stocks took off after last week's oral arguments concluded, it appears that the subsidies will remain in place.
It's been five years this month since Congress passed the ACA into law. Medicare was entrenched into the American healthcare system by 1970, five years after it was legislated into existence. So was Social Security by 1940 (the goings-on in Europe and Asia meant America had more important actions to take than pry cash from the hands of senior citizens).
One of the problems with the ACA is the Obama administration has been decidedly detached about giving its full-throated support to the law. Now that he's a lame duck with an oppositional Congress, it's time for President Obama to change the tone and take the lead.
He could do that with a simple five-minute speech declaring that the ACA is the law of the land, pronounce its benefits (millions fewer uninsured) and announce that litigation over the issue is now "closed." Moving forward, the efforts of the American people would focus on improving rather than repealing the law.
President Obama could even issue an executive order to that effect, although the constitutionality of such an action--and the attendant politics--would be questionable at best.
In the meantime, the government could focus on improving the ACA by considering the following:
Healthcare cost trends abated mostly as the result of the Great Recession, but signs have suggested they will perk up again. The ACA's cost controls have been piecemeal. A more integrated approach and more programs to experiment with cost reductions are sorely needed.
There are still more 20 states that have yet to expand Medicaid eligibility, to the great detriment of both their citizens and hospitals. Most of the efforts have been pushed by state and regional hospital associations, which have relatively little influence. Its time for the American Hospital Association and the Federation of American Hospital Systems to get involved. And if the AHA can spend the time and effort to get the IPAB repealed, it can make sure the rest of the ACA remains intact.
If Medicaid expansion can't be accomplished everywhere, reverse the Disproportionate Share Hospital program payment cuts in those states that remain holdouts. And address the income-based eligibility gaps that prevent individuals from obtaining tax subsidies because they earn too little--and exclude them from Medicaid because they earn too much.
In three months, the Supreme Court should render its decision on King v. Burwell and the fight over the ACA will and should be over. Both sides need to make peace and improve the single most important piece of legislation passed to date in this century. - Ron (@FierceHealth)
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