A step on path to better health care
The U.S. Supreme Court ruled in the case of King v. Burwell Thursday to uphold the provisions of the Affordable Care Act that provide subsidies to millions of Americans to assist them in buying private health insurance through health insurance exchanges.
These exchanges, or health insurance marketplaces, could be established either by a state or by the federal government if a state elected not to establish its own.
The ACA provided for subsidies for most people who have purchased insurance through an exchange because their incomes are between 100 percent and 400 percent of the federal poverty level (or $11,770 to $47,080 for individuals) and have no other access to insurance.
At issue was the intent of Congress to provide these subsidies for individuals who purchased health insurance through exchanges operated by the federal government or whether the ACA only provided for such subsidies for people who purchased coverage through an exchange established by their state.
The decision, by a 6-to3 majority, ruled that subsidies are permitted for people with insurance through either federal or state-run exchanges. This ruling is important for Tennessee, as Tennessee was one of 34 states that opted for the federal government to operate the insurance exchange for its citizens.
It allows more than 200,000 Tennesseans with health insurance purchased through the federal marketplace to continue to receive subsidies. Without the subsidies, insurance would be unaffordable for many, and as many as 80 percent of the current recipients could have become uninsured.
The Supreme Court’s ruling is thus clearly an important step in expanding access to insurance and essential health care services to all Tennesseans. It is, however, critical to recognize that it is only a step toward the unrealized twin goals of health insurance coverage for all and an improved health care delivery system that provides high quality of care to all at a reasonable cost.
Although the percentage of Tennesseans with insurance coverage has fallen from 15 percent in 2008 before the enactment of ACA to 12.5 percent in 2014, more than 818,000 residents remain without coverage. The consequences to these people as well as to all Tennesseans are critical.
The lack of health insurance is associated with substantially limited access to needed health care, lower health status, higher rates of personal bankruptcy and, most important, more hospitalizations and deaths that are otherwise avoidable.
The economic consequences to the community are also significant; poor health reduces productivity and diverts public and private funds from other community needs. The state legislature’s decisions not to expand Medicaid as permitted by the ACA and not to implement Gov. Bill Haslam’s alternative Insure Tennessee plan deprived some 300,000 Tennesseans of access to health insurance and were major blows against the goal of coverage for all.
In addition, other problems in our health care system remain to be fixed. The high cost of care, lack of coordination between and among hospitals and primary care, and a lack of emphasis on prevention remain important health system reform challenges.
Thus, now is not the time to simply sit back, satisfied with the assurance that subsidies will continue to help people in need purchase insurance. Rather, it is time to use this ruling as a basis to strengthen the momentum to develop and to implement plans to further expand insurance coverage to all and improve the delivery of health care.
The King v. Burwell ruling supporting the ACA is only one step, albeit an important one, on the road to a truly effective health care system that provides high-quality care at a reasonable cost for our state.