Public health advocates and providers who serve large populations of low-income patients say Thursday's U.S. Supreme Court ruling was vital toward ensuring healthcare access to the most vulnerable patients.
The court ruled 6-3 to uphold an earlier ruling that made tax credits available to individuals who purchased health insurance through the federal exchange.
The loss of subsidies for an estimated 6.4 million Americans would have added economic burdens for many of the country's public hospitals, which are facing the threat of declining revenues as a result of pending cuts to the Medicaid disproportionate-share payments program.
Those payments have been used to offset the costs incurred in providing uncompensated care. The bulk of payments have traditionally gone to safety net hospitals serving large low-income populations.
Both Medicare and Medicaid DSH payments covered $21 billion of the $44 billion in uncompensated-care costs hospitals amassed in 2013, according to a May 2014 study published in Health Affairs.
“In non-expansion states it would have been a triple whammy,” said John Haupert, CEO for Grady Health System in Atlanta. “We would have had to start having discussions with our board and the community about which clinical services we could no longer provide to afford with those kinds of cuts.”
“Much of what we do in Palm Beach County for healthcare with the uninsured and underinsured would have really been in jeopardy if all of a sudden the subsidies were to go away,” said Dr. Ronald Wiewora, CEO for the Health Care District of Palm Beach County, Fla., where an estimated 136,000 individuals receive health insurance premium subsidies.
Many say the court's ruling helped to eliminate much of the ambiguity around the future of the healthcare law, which proponents for Medicaid expansion are hoping will help to strengthen their argument for expanding access to adults earning up to 138% of the federal poverty level in the remaining 21 states that have yet to expand coverage.
“We still have a long way to go to solve the nation's health insurance crisis and ensure affordable and available care for all people,” America's Essential Hospitals CEO Dr. Bruce Siegel said in a statement. “About 37 million people still lack health coverage in the United States, in part because 21 states still have not expanded Medicaid. We hope this decision will give states the confidence to extend coverage to the millions of vulnerable people who need it.”
Dr. Georges Benjamin, executive director of the American Public Health Association, said much more focus must now be given toward expanding Medicaid in non-expansion states by highlighting the negative economic and health impacts the decision not to expand has had for government budgets, providers and patients in those states.
“There is strong correlation between some of the worse health outcomes in the nation and the lack of Medicaid coverage,” Benjamin said. “We can't become the healthiest nation if we don't first address the impact a lack of coverage has had for hospitals and patients.”
Benjamin said the King v. Burwell case has helped spark what he called a “national conversation around health,” which he expected will put public pressure on lawmakers to provide greater healthcare access to more Americans.
“I believe the public is going to see through the lies and distortions against the Affordable Care Act and begin to demand their elected officials do something to cover people who are uninsured,” Benjamin said.
“I believe the public is going to see through the lies and distortions against the Affordable Care Act and begin to demand their elected officials do something to cover people who are uninsured,” Benjamin said.
South Dakota resident Kelsey Collier-Wise said she felt “relieved, very relieved” after learning about the high court's decision.
“It was a pretty huge part of our income,” she said. “Not having to worry about that to the same extent, having basically the affordable insurance, has just made a huge amount of difference in the wiggle room we have every month.”
Collier-Wise and her husband pay about $261 a month for their plan after a subsidy of $336 a month through the exchange. Her 5-year-old daughter is now covered through Medicaid, and before she signed up for coverage through the exchange, Collier-Wise paid roughly $750 a month to cover the whole family.
“This is going to save us obviously a good deal of money,” Collier-Wise said. “We couldn't have kept the plan that we have now at the price that it was."
