PPACA and the Supreme Court: Round Two


The changing of winter to spring outside my window makes me wonder what the summer will bring, both for me, and more importantly, for healthcare reform, especially with such a big decision in front of the Supreme Court.

Since the 1990’s, healthcare reform has been on the horizon, and like the changing seasons, it’s finally here – in one form or another. Some of the issues taken on in the Patient Protection and Affordable Care Act (PPACA)  legislation have been necessary and greatly needed, such as being able to keep college age dependents on their parent(s) health insurance, removing pre-existing condition clauses, some of the minimum coverage terms, and a variety of other issues.

With all these great “reforms,” why all the uproar? Let’s take a closer look at the change and why it matters.

PPACA goes further than reforms and legislates an expansion of Medicare coverages as well as implementing a scale of affordability subsidizing for individuals with funding coming from large employers paying penalties. This is the meat of the litigation: the wording and interpretation of the law.

But has the PPACA’s interpretation usurped the state’s rights or not? If there is not a state offering individual subsidies, then there is not an employer mandate penalty in that state. This is a big deal for large employers as well as individuals. Subsidies are great for individuals, but what about the companies with entry level jobs, or staffing and hospitality companies? This includes fast food companies, gas stations, and many retail operations.

If the Supreme Court rules that the PPACA should function as written, then the largest impact of the PPACA, the individual subsidies and the employer mandate are null and void. People receiving subsidies will drop their coverage because of plan cost. This loss of insurance enrollees is causing a fear that the cost of medical insurance will climb because of those who stay on with high cost medical conditions, causing premiums to rise faster than ever. This shift in enrollments will move control back to the states and individuals. The other side of the argument is that the intent of the law is to have everyone covered by medical insurance. But again, the PPACA has not completely curved the spiraling cost of medical coverage.

Insurance depends upon the law of numbers. A carrier hopes to enroll more healthy individuals/families than those with existing major conditions. By requiring carriers to take all, they need all enrolled to balance the books.

This description is definitely a simplified look at the PPACA and the case before the Supreme Court. Either way, the ruling comes down to the fact that change is ahead. Like moving from winter to spring, there are many welcomed changes coming like sunshine and flowers; but with the flowers comes the weeds.

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