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Jun 19 2012   10:15AM GMT

Moving health care ahead — with or without ACA

Posted by: Jenny Laurello

Guest post by: Claudia Page, Co-Director, Social Interest Solutions

As we wait for the Supreme Court justices’ final ruling on the constitutionality of the Patient Protection and Affordable Care Act (ACA), we must be mindful of the original intent of the law: modernizing the country’s health and human services infrastructure, improving operational efficiencies, enhancing overall consumer experiences and increasing coverage.

Regardless of the Court’s decision, the health care law has already planted seeds that will forever alter the health and well-being of many of the nation’s residents. Even if the individual mandate is struck down, the entire bill is rescinded or any outcome in between, the federal government and states can – and should – continue to overhaul how health benefits are accessed and delivered.  Though federal financing will still be required, it is essential for the nation to continue to foster improvements in several key areas regardless of the Supreme Court ruling.


Eligibility and Enrollment

The ACA vision is that while some consumers will require assistance when applying for coverage, the vast majority of consumers will enroll in public, subsidized, and private coverage online, by themselves.  Real-time is the new vision: As much as possible, verifications will be done electronically by matching data against federal and state databases, rather than making consumers provide hard copy documentation for pay stubs, birth certificates, etc., as they do now. Renewals will be automated – thereby replacing the multi-step, time-consuming and inefficient renewal processes in place today. This will ensure continued coverage for eligible consumers. Options for supporting real-time eligibility and enrollment have already been identified by states working to meet these requirements of the ACA.

Not too long ago, the Department of Motor Vehicles (DMV) took similar steps to put most of its business online to enable consumers to register vehicles, change addresses, pay parking tickets and more in real-time.  The Center for Medicare & Medicaid Services (CMS) should strive to modernize eligibility and enrollment systems to make enrolling in public and private health programs as easy as renewing a license – with our without the ACA as we know it today.

While the ACA defines eligibility and enrollment requirements for Medicaid and the Child Health Insurance Program (CHIP), eligibility and enrollment policies for other benefit programs are mentioned but not specifically addressed by the law. Programs such as Supplemental Nutrition Assistance Program (SNAP formerly Food Stamps), Temporary Assistance to Needy Families (TANF) and a variety of other federal, state and local programs (e.g., LIHEAP, EITC and Unemployment Benefits) should also be considered when revamping eligibility and enrollment systems. It only makes sense for states to consider adopting the modernized eligibility and enrollment policies and systems set forth in the ACA to support an even wider array of benefit programs.  Providing a far more efficient and effective enrollment process will save consumers and state workers time and provide more accuracy and efficiency.

Medicaid Expansion  

The Medicaid Expansion provision of the law extends Medicaid coverage to all adults under the age of 65 with incomes at or below 138% of the Federal Poverty Level (FPL), which is a big expansion for many states. Single adults earning up to $14,404 or a family of four with incomes up to $29,327 across the nation will now be eligible for Medicaid.  That translates to roughly $15 million low-income Americans.  This expansion will reduce the number of people without health insurance and decrease the otherwise uncompensated costs for the uninsured. The Medicaid Expansion provision will also help protect residents against preventable illnesses and likely result in a healthier workforce.


Should the Supreme Court rule that the individual mandate is the only unconstitutional element of the law – leaving  the rest of the ACA standing, including the Medicaid Expansion – states should harness the financing that will presumably remain available as part of the ACA.  It only makes sense to continue to improve and replace outdated, siloed IT systems that today inefficiently support Medicaid, and implement innovative Medicaid reform measures.  


Health Insurance Exchanges

One of components the ACA is the mandate for states to establish health insurance exchanges. The purpose of an exchange is to provide consumers and small businesses a single point of entry to obtain public or subsidized coverage or to buy affordable private health insurance coverage. States can choose to  establish their own exchange, utilize the federal insurance exchange or enter into a partnership with CMS to provide an exchange. Health insurance exchanges could certainly function without the mandate. There is great benefit in providing consumers the opportunity to select among competing insurers offering standardized products so they can easily compare offerings and make smart choices.


In addition to offering health insurance exchanges, states should offer insurance affordability programs including Advanced Premium Tax Credits (APTC) and Cost Sharing Reductions (CSRs) even if the individual mandate is struck. These important components of the ACA will assist people who make too much to qualify for Medicaid, but are still lower-income households struggling to afford health insurance. By using the APTC and CSR to offset the cost of monthly insurance premiums, coverage will be more affordable for this population.  Lowering out of pocket costs can make a big difference and, hopefully, will offer a real incentive to purchase health insurance.  Increasing the number of people who have insurance helps to lower overall risk and thereby the overall costs.  This is a win-win strategy and states should not abandon such programs in the event the mandate is struck from the ACA.


ACA: Win or Lose – We Still Could Win

As we cautiously await the final verdict from the Supreme Court, we must remember the core tenets of the ACA – modernizing eligibility and enrollment systems, expanding coverage for those in need, making insurance more affordable, understandable and accessible for millions of uninsured Americans. With or without the ACA, these goals are vital to the stability of the nation and the health and well-being of the population of the U.S. With so much at stake, these changes can (and must) happen – with or without the ACA.

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