Overturning the ACA would leave Illinois—and the 38 other states (plus Washington, D.C.) that have expanded Medicaid—without the federal matching dollars needed to cover the cost of the health insurance program. (The federal government pays 90 percent and states pick up the rest.) Roughly 600,000 Illinoisans likely would lose coverage as a result.
“It’s unlikely that any state would be able to jump in and shoulder that burden,” said Adam Searing, an associate professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.
The federal funds would stop flowing at a time when states’ budgets are reeling. Illinois especially is in deep financial trouble with the collapse of Gov. J.B. Pritzker’s proposed graduated income tax proposal.
The case, challenging the entire ACA, was brought by Republican state attorneys general and supported by the Trump administration. A lower court late last year ruled the ACA’s individual mandate, which initially required people without health insurance to pay a financial penalty, is no longer constitutional since the fee was eliminated by the 2017 Tax Cuts & Jobs Act.
Meanwhile, advocates argue Medicaid expansion under the law “has a big effect on an individual’s financial security,” Searing said. “When (people) have less medical debt, they’re more likely to be able to pay their rent, they’re less likely to get evicted from their housing. That financial security is a huge component of the expansion. … It’s not just people losing their health coverage. The state is losing a lot of economic activity too.”
Indeed, a full ACA repeal would take a toll on the local health care system, which will still be dealing with the economic fallout from the COVID-19 pandemic.
The Springfield-based Illinois Primary Health Care Association, a network of community health centers, tweeted today in support of Obamacare, saying the law has “helped to narrow health inequities.” In a separate post, it said Medicaid expansion, in particular, “is vital to alleviating health disparities and racial inequities.”
More residents without health insurance would lead to a higher burden of uncompensated care. Such a shift would disproportionately affect safety-net hospitals that treat large numbers of poor and uninsured patients. It also could lead some patients to put off testing or treatment for COVID-19, inadvertently exacerbating the outbreak.
Cook County Health estimates the impact on the health system of an ACA rollback would be roughly $1.4 billion annually, including increased uncompensated care costs and lost revenue from CountyCare and other Medicaid managed care plans.
At the end of the day, the Supreme Court’s decision could destabilize the framework that the health care industry has operated under for a decade. There’s also a possibility that Congress will be divided between Democratic and Republican control next year, which would complicate any legislative response to the court’s decision.
“A Senate-controlled by Republicans would be a big obstacle,” Wendy Netter Epstein, professor and faculty director of DePaul University’s Jaharis Health Law Institute, said. “An optimistic person might look at the fact that even some red states took the Medicaid expansion and have seen positive results as a signal that maybe the GOP would get behind a patch to continue the Medicaid expansion.”
The Supreme Court is expected to rule in California v. Texas by June 2021.
Here’s an overview of today’s oral arguments:
The justices focused on issues including whether challengers had legal standing and whether the entire law would have to fall if the zeroed-out individual mandate were found unconstitutional.
Chief Justice John Roberts and Justice Brett Kavanaugh are considered the swing votes in California v. Texas. Both justices in their questions to Texas’ solicitor general indicated they may be willing to sever a zeroed-out individual mandate from the rest of the law.
Kavanaugh commented that he may find a zeroed-out individual mandate unconstitutional because it does not raise revenue, but said the rest of the law seems to be severable.
"It does seem fairly clear that the proper remedy would be to sever the mandate and leave the rest of the act in place," Kavanaugh said.
Modern Healthcare reporter Rachel Cohrs contributed.
via Crain’s Chicago Business
November 10, 2020 at 06:19PM