SCOTUS and the ACA: A Cheat Sheet

On June 25, 2015 the Supreme Court voted 6-3 to uphold the Affordable Care Act. Essentially, the Court ruled to allow the federal government to provide subsidies for health care coverage purchased on public exchanges regardless of whether those exchanges are state or federally run. 34 states have federally, rather than state, run public health exchanges.

This pretty much guarantees that the ACA will live on after Obama leaves office in 2017. Here's a brief breakdown on what this means and how it might impact you.

What this means for you:

If you have a state or federally based marketplace plan for 2015, don’t worry. There will be no changes to your health insurance plan this year (read on via Aetna). Your plan or coverage might change for 2016 if you have reportable changes in your income or household. For information on changes you must report and how to report them for 2016 coverage, check out HealthCare.gov.

By the way - the 2016 enrollment period is Nov 1, 2015 - Jan 31, 2016!

Uh, what are public health exchanges?

Health exchanges are places where people without insurance can shop for individual health plans. According to the NYTimes, 85% of people who use the exchange also qualify for subsidies to help pay for coverage. Meaning that the majority of people using the exchange would most likely otherwise be unable to afford health care.

An aside - we think the way Stride Health and Oscar are innovating around individual health insurance is pretty cool.

How’d this come about?

The Affordable Care Act was first brought in front of the Supreme Court in 2012, when the Court upheld the ACA as an exercise of Congress’s taxing power but denied the ACA’s ability to force states to expand Medicaid provisions. This time, the issue revolved around the phrase that subsidies were available for those who bought insurance on “an exchange established by the state.” The Court ruled 6-3 to determine that federal subsidies could be used in state’s without their own public exchange programs.

Those opposed to the act argue it raises the cost of health care for families and small businesses and puts the federal government at the helm of an individual’s health care plan.

The ACA guarantees coverage for all Americans regardless of pre-existing conditions and expands Medicaid. This means that more Americans have access to health insurance. It also requires that most Americans obtain insurance or face a tax penalty.

The idea behind expanding coverage to the greater population is to avoid death spirals - the infamous phenomenon that posits only sicker, more expensive, populations will want healthcare coverage while healthier populations avoid paying for insurance they don’t need, thus raising prices for everyone until the health insurance market is totally destabilized.

Many feared that should the court overturn the Affordable Care Act, it would guarantee the very destabilization it was created to prevent.

 

Author Beam Tech

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