Meet­ing the chal­lenges

Rul­ing means full at­ten­tion can be turned to build­ing ex­changes, en­roll­ment

Modern Healthcare - - OPINIONS COMMENTARY -

With last week’s rul­ing, we can now keep mov­ing for­ward to en­sure that peo­ple in this coun­try will have the peace of mind that comes from know­ing that they and their loved ones are sure to get the health­care they need when they need it.

We are now closer than ever to en­sur­ing that peo­ple with pre-ex­ist­ing con­di­tions— such as chil­dren with asthma or di­a­betes— will not be de­nied cov­er­age or charged dis­crim­i­na­tory pre­mi­ums. Peo­ple with ma­jor health prob­lems, such as those in car ac­ci­dents, will no longer face an­nual or life­time lim­its on their cov­er­age. Women will no longer be charged higher health­care pre­mi­ums sim­ply be­cause they are women. Tens of mil­lions of Amer­i­cans will soon have the se­cu­rity of good qual­ity, af­ford­able health in­surance. And the mil­lions of oth­ers who are al­ready en­joy­ing ben­e­fits of the law—from young adults now cov­ered on their par­ents’ plans to se­niors sav­ing money on pre­scrip­tion drugs—can rest easy know­ing their pro­tec­tion will not be taken away.

Re­gard­ing Med­i­caid, while I would have pre­ferred that the U.S. Supreme Court leave in­tact the en­tire Med­i­caid pro­vi­sion, I am op­ti­mistic that the rul­ing will have lit­tle prac­ti­cal ef­fect. Un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act, the fed­eral gov­ern­ment will pay 100% of the costs of cov­er­ing the roughly 16 mil­lion newly el­i­gi­ble Med­i­caid ben­e­fi­cia­ries for the first three years the law is in ef­fect, and never less than 90% of the costs there­after. This com­pares with a fed­eral share av­er­ag­ing 57% of the costs un­der the reg­u­lar pro­gram.

Al­though states, un­der to­day’s rul­ing, are no longer re­quired to ex­pand their Med­i­caid pro­gram, the of­fer of 90% to 100% fed­eral fund­ing to cover the health­care costs of their low­est-in­come res­i­dents is sure to ap­peal to peo­ple in ev­ery state. All states have al­ready done this with the op­tional Chil­dren’s Health In­surance Pro­gram, which has a lower fed­eral match­ing rate. Even an ide­o­log­i­cally driven gover­nor would be com­mit­ting fis­cal mal­prac­tice by re­ject­ing the ex­pan­sion.

With the le­gal bat­tles be­hind us, we at last can turn our full at­ten­tion to some of the most chal­leng­ing and prac­ti­cal tasks that lie ahead in the next few years, from build­ing the in­surance mar­ket­places, known as ex­changes, to the mas­sive out­reach and en­roll­ment ef­forts needed to make sure that peo­ple know about, and take ad­van­tage of, the new cov­er­age op­tions that will soon be avail­able to them.

The pub­lic, pri­vate and not-for-profit sec­tors must col­lab­o­rate on out­reach and pub­lic ed­u­ca­tion so that peo­ple can learn about and choose the health­care op­tions that are best for them. This is not al­ways glam­orous work, but it is es­sen­tial to mak­ing the law reach its full po­ten­tial.

Ron Pol­lack is

the found­ing ex­ec­u­tive direc­tor of Fam­i­lies USA.

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