Countdown to Chaos or Advancement? Guest Blog by Jan Hudson

Countdown to Chaos or Advancement?

We are now only days from the much anticipated Supreme Court ruling on the Affordable Care Act. The potential and far-reaching impacts of the Supreme Court’s decision on the fate of the ACA are mindboggling when considering how much is at risk and the tremendous progress and positive momentum that could be instantly reversed.

The stakes are high for all Americans.

The ruling — declairing the law constitutional, striking down the entire law or a portion of it – will have enormously different consequences. (Declaring a portion unconstitutional could involve the individual responsibility provision that requires most people to enroll in or purchase healthcare coverage if it’s affordable or the Medicaid expansion that covers all with incomes below 133% of the poverty level.)

Without the full protections of the ACA, we are all one job, one accident or one illness away from insecurity or ruin.

Millions of Americans have obtained coverage and protections from the law’s 25 provisions already implemented; millions more await 2014 when full implementation will expand Medicaid coverage and provide more coverage opportunities with subsidies through the new marketplaces.

Should the Medicaid expansion or the entire ACA be ruled unconstitutional, the impact on the Medicaid program and low-income parents and adults will be profound. Hundreds of thousands of low-income childless adults in Michigan would lose the opportunity for comprehensive coverage in 2014, as would parents, currently eligible for Medicaid only with incomes below about 50% of the poverty level.

If the ACA is ruled unconstitutional, protections, known as “maintenance of effort,” for current Medicaid categories would be eliminated, once again opening the door to proposals to eliminate coverage for “optional” Medicaid groups such as caretaker relatives and some young adults.  Under the ACA, state Medicaid programs must maintain eligibility for all covered groups as of the law’s signing in March 2010.

Due to the unprecedented scope of this appeal, the impacts and resulting actions will not be known until the ruling is issued.  Following are a few key questions that will remain unanswered in the meantime:

• Will benefits currently enjoyed by individuals be immediately eliminated – protecting children with pre-existing conditions, phasing out annual and lifetime limits and keeping young adults on their parents’ coverage?
• Will those adults with pre-existing conditions who gained coverage through the Health Insurance Program (HIP) for Michigan immediately lose their benefits?
• Will ongoing declines in employer-sponsored coverage continue to result in higher rates of uninsured rather than opportunities for individuals and small businesses to purchase through the new healthcare coverage marketplaces?
• Will harmful insurances practices be immediately restored –premium increases with little oversight or review, less accountability of how insurers spend premium dollars, resulting in high administrative costs and profits?
• Will consumer protections be eliminated – returning to cancellation of coverage when someone becomes ill, discriminatory rates and noncomprehensive services for women?
• Will the Medicare Part D “donut hole” return to growing each year, rather than closing under the ACA?

If provisions of the law, or the entire law, are struck down, the issues Congress sought to address through the ACA will not simply go away. They will get worse. Rising healthcare costs, the ability to access affordable, quality coverage, and the healthcare delivery system must be addressed in a meaning way.

Will the justices set-aside politics, ideology, and personal preferences and confirm the constitutionality of the law as did two Circuit Courts of Appeals, and uphold the vital protections for all Americans as well as the interests of business?

Time will tell; the countdown is under way.