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ACA Ruling Jeopardizes Patient Care Access, Access to Coverage

An official overturn of the Affordable Care Act could put at risk patient care access and access to payer coverage, industry leaders say.

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Source: Thinkstock

By Sara Heath

- Healthcare industry leaders have concerns about patient care access and patient access to payer coverage in light of the recent rulings on the Affordable Care Act (ACA), although most experts are confident in an eventual appeal.

Late last week, US District Judge Reed O’Connor ruled that the ACA is unconstitutional because of changes made to the law at the beginning of 2018. Specifically, Judge O’Connor ruled that the stripping of the individual mandate in 2018’s tax overhaul bill invalidates the rest of the ACA.

The individual mandate was integral to the law’s intent, Judge O’Connor reasoned. If it was ruled that the mandate was an overreach of Congressional power, so too was the rest of the ACA.

To be clear, the ruling does not yet bear any impact on the ACA, those enrolled on exchange health plans, or the open enrollment process that ended on December 15.

CMS confirmed such in a statement following the ruling.

“The recent federal court decision is still moving through the courts and the work of the Innovation Center will continue unchanged,” the agency stated. “We remain committed to our current and future models as well as our focus on better health outcomes at lower cost.”

Despite those assurances, patient care access and ability to obtain comprehensive and reasonably-priced insurance coverage remain in question. The ruling is sure to create a frenzy of confusion, in turn potentially destabilizing the insurance marketplaces.

In the longer term, leading industry groups expressed concern for the fate of the ACA, stating that dismantling the law would put millions of patients at risk for losing health insurance and subsequently losing access to healthcare.

Rick Pollack, president and CEO of the American Hospital Association (AHA), acknowledged the numerous patients who suffer from pre-existing conditions and who, without the protections included in the ACA, would face insurmountable costs for health payer coverage.

“America's hospitals and health systems are extremely disappointed with today's federal district court ruling on the constitutionality of the ACA,” Pollack said in a statement. “The ruling puts health coverage at risk for tens of millions of Americans, including those with chronic and pre-existing conditions, while also making it more difficult for hospitals and health systems to provide access to high-quality care.”

American Medical Association (AMA) president Barbara L. McAneny, MD, stated that should the ruling be carried out, the healthcare industry would be thrust back into a past where patients struggled considerably to access healthcare.

“Today’s decision is an unfortunate step backward for our health system that is contrary to overwhelming public sentiment to preserve pre-existing condition protections and other policies that have extended health insurance coverage to millions of Americans,” McAneny said in a statement. “It will destabilize health insurance coverage by rolling back federal policy to 2009. No one wants to go back to the days of 20 percent of the population uninsured and fewer patient protections, but this decision will move us in that direction.”

Any limitations to the ACA would remove opportunities for consistent healthcare, said the Academy of American Medical Colleges (AAMC), which would be detrimental to the nearly one in four Americans who report having a pre-existing condition.

“Patients—particularly those with preexisting and complex conditions—require stability and continuity in their care,” said AAMC president and CEO Darrel G. Kirch, MD. “Without access to affordable meaningful coverage, many would forego or delay necessary medical care. This ruling puts millions of Americans, including the most vulnerable patients, at risk.”

Each of the industry leaders did express hope in an appeals process, however. Following the ruling, a coalition of 16 states and the District of Columbia issued a motion to clarify Judge O’Connor’s ruling. This comes as a part of the industry’s efforts to stabilize the marketplaces. Additionally, the group of Attorneys General called on a stay pending an appeal.

Those actions met the expectations set by AHA, AAMC, and AMA. Additionally, the groups expressed support for those appealing the ruling.

“As this case proceeds through the appeals process, the AAMC will continue to fight to ensure that all Americans have access to the health care they need,” Kirch concluded in his statement.

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