In late March, the Patient Protection and Affordable Care Act (ACA), the legislation driving what many have come to refer to as simply “federal health care reform,” celebrated its second anniversary.
While some states, California in particular, have made huge strides in implementing aspects of the law, a round of oral arguments that recently took place before the Supreme Court has cast renewed doubt on whether major – and would some say vital – aspects of the law will be allowed to stand.
Much of the debate around the law’s constitutionality revolves around the “individual mandate” that would take effect in 2014. The question, critics ask, is whether the federal government has the authority to require citizens to purchase goods, or face a penalty for not doing so.
Should the mandate be struck down, the debate’s focus would then shift to what, if any, provisions of the law will be allowed to move forward.
In California, which has been a leader in reform implementation, the question would be a pressing one.
Last week, state Health and Human Services Secretary Diana Dooley said that Governor Jerry Brown’s administration hopes to move forward with aspects of reform even if the law is struck down. This commitment should come as a surprise to none, considering the steps toward implementation the state has taken since 2010.
Shortly after President Barack Obama signed the ACA, California became the first state to pass legislation establishing its Health Benefit Exchange. (Massachusetts and Utah both had exchanges in place before the ACA was signed.)
The independent body responsible for bringing the Exchange online, the Health Benefit Exchange Board, has been working – under the guidance of the federal Department of Health and Human Services – to select an Essential Health Benefits package, while also soliciting feedback about standards relating to qualified health plans that will be offered under the Exchange.
Together, these two aspects form the cornerstone of the new health insurance marketplace that would be established through the Exchange.
While the Exchange Board certainly has a long road to travel before full implementation, the loss of the individual mandate would create questions over whether it would be fiscally possible for insurers to provide the type and volume of coverage promised under the ACA.
These questions will only fully be answered when the Supreme Court issues its ruling later this year. Until then, stakeholders will be anxiously awaiting some added clarity.
For a more in-depth reaction to the Supreme Court oral arguments, as well as information on how the ruling could affect ACA implementation in California, look for the coming edition of CMA’s latest newsletter, CMA Reform Essentials.