What Hurdles Remain for the ACA after Burwell?

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With the dust settling after last week’s Supreme Court decision in King v. Burwell, focus is turning toward the hurdles that remain for the Affordable Care Act (ACA) going forward.

  • Enrollment in Exchanges – As Exchanges prepare for their third open enrollment period, they continue to face challenges in attracting certain segments of the population who are reluctant to buy and enroll in coverage.  As the tax for not having coverage under the Individual Mandate increases, it may be that these populations may change their minds but it will also be up to the Exchanges to effectively outreach to these groups to boost enrollment.
  • Medicaid Expansion – To date, twenty-one states have declined to expand Medicaid to individuals in their states with incomes near the poverty line.  It is estimated that an additional 4 million people could be covered under Medicaid if expanded into these twenty-one states.
  • Increasing Health Care Costs – With costs continuing to increase, innovative approaches to control those costs are evolving, including accountable care organizations, value-based purchasing and incentives for providers to provide better and more efficient care.  It is hoped that these innovative approaches, along with programs to detect waste and fraud, will lower the overall cost of health care.
  • Market Stability – The ACA included three premium stabilization programs designed to protect issuers offering plans on the Exchanges from high claims costs and to ensure that they were not inaccurately setting rates to try and off-set those costs.  Two of the programs are temporary and set to end in 2016.  While premiums for Exchange coverage have remained fairly stable the first two years, it remains to be seen if they will increase once the two temporary stabilization programs end.

One other remaining hurdle is the ongoing political resistance to the ACA.  With the 2016 presidential campaign ramping up, calls for repealing the law are likely to continue for the foreseeable future.