BLOG — What Happens if the Supreme Court Invalidates the ACA

This post was originally published in The Buffalo News

by Michael W. Cropp, MD
President and CEO, Independent Health

Last week, the U.S. Supreme Court heard oral arguments in the case of California v. Texas, its third major case regarding the Affordable Care Act (ACA). The court’s decision, expected to be issued in June 2021, could determine the fate of the ACA, commonly known as “Obamacare.” At stake is health insurance coverage for more than 21 million Americans.

The ACA enacted several positive steps toward broader health care reform. In addition to expanding access to affordable health care and instituting protections for people with pre-existing conditions, the ACA prompted health insurance plans to implement innovative payment models, integrated care delivery and other quality improvements.

The Supreme Court has several options in deciding the case, many of which hover around the question of severability and whether the rest of the ACA can stand if the individual mandate is ruled unconstitutional. Five justices, including two members of the court’s conservative majority, have indicated they might reject attempts to strike down the law in its entirety.

We’ve heard a lot about the possibility of getting rid of this health care law, but have seen no comprehensive alternative. However, we do have options.

It’s important to remember health care reform cannot be accomplished by any one entity, including the government. It is a collective responsibility requiring community ownership, innovative thinking, wide-ranging partnerships, and collaboration among the public and private sectors.

Some would point to other countries’ single-payer, government-run health care systems as examples to emulate. However, to stay within budget, these systems must often ration care and wait times for essential health care services like diagnostic imaging can be staggering.

New York State has been successful in providing access to health insurance to more than 95 percent of state residents, though some state legislators favor a state-sponsored, single-payer system. A 2018 study commissioned by the non-partisan New York State Health Foundation reported a single-payer health insurance plan could work in New York, but would require massive tax increases.

An ideal health care system balances high-quality, well-coordinated care (that places an emphasis on prevention) and timely access to needed services with a sustainable economic model assuring coverage for all citizens. This ideal has been very hard to achieve in most other countries of the world. However, we do have an example of a system of care in the U.S. that begins to approach this ideal – the Medicare Advantage program.

With Medicare Advantage, the government subsidizes a majority of the cost for health coverage for seniors, and individuals shop for a plan they feel best meets their needs. Medicare Advantage offers many benefits, including more convenient service provided by private health plans and long-term savings.

Under an expanded Medicare Advantage program, health care would stay local. It’s not realistic for the federal government to adopt a national health care policy that works for every community across the country. What works for Los Angeles is not going to work for Western New York.

The Medicare Advantage model not only works, it’s popular. According to the Kaiser Family Foundation, enrollment in Medicare Advantage plans nearly doubled from 2008 to 2018.
Expanding Medicare Advantage to those under age 65, would achieve an effective combination of government subsidy and privately run health insurance – a combination leading to more efficient care, lower costs and increased consumer choice.

Medicare Advantage serves as an example of a viable alternative. However, no matter the outcome of this important court case, we must continue to collectively work toward meaningful health care reform that addresses, first and foremost, health care disparities, and places a focus on preventive services, embracing technology, and improving efficiency and outcomes.


 Michael W. Cropp, M.D., is an ACHP board member, the president and CEO of Independent Health and a board-certified family physician.


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