Supreme Court lets reform live on. Now what?

Dina Overland


It goes without saying that the prevailing, dominant news of the week was the Supreme Court ruling that the health reform law is constitutional. So as I've been saying for almost two years now right here in this column, reform is indeed here to stay.

So now what?

"The decision is a critical watershed moment," Ralph Tyler, former Maryland Insurance Commissioner and current partner in law firm Venable's litigation and government Divisions, told FierceHealthPayer. "It shifts the focus from the question of whether we will have healthcare reform to the question of how it's to be implemented."

And, maybe more importantly and relevant to the conversation at hand, the decision compels insurers and states to be actively engaged in implementing what is a "truly significant piece of legislation" that changes the entire healthcare system.

"Overall, the ruling is very much a net positive for health insurers," Tyler added.

But before payers get all high and mighty in the aftermath of the very favorable decision, they must recognize that more work needs to be done--a lot more.

Insurers will be covering more people, including some who currently don't have or couldn't get insurance because of health conditions, as a result of Medicaid expanding. That means they must get their policies and practices in line with reform requirements, for example providing coverage to people irrespective of health conditions and complying with medical-loss ratio requirements.

Plus, insurers must "build the infrastructure to handle the huge increase in the number of insured customers," Tyler said. "Building systems to handle applications, claims, premiums and subsidies is going to be critical."

For insurers looking to get ahead in the burgeoning individual market, they "will need to engage in stakeholder discussion, helping frame how that individual market ends up looking like in states where they want to play and accelerate their ability to sell into that market effectively," Mark Lutes, attorney with Epstein Becker & Green, told FierceHealthPayer. They should be evaluating how to reach the individual market from a media image and consider new partnerships.

"There will be many interesting partnerships with non-healthcare insurance players to reach that market and effectively handle the healthcare of that market once they're enrolled." Deals like Aetna selling wellness kits at Best Buy or individual health plans at Costco are "going to be the tip of the iceberg," Lutes added.

Essentially, it's time for health insurance companies to stop wondering whether reform will actually come to fruition. It's here, it's staying and it's time to hit the ground running. --Dina (@HealthPayer)

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