BCBS Louisiana CEO Mike Reitz
Las Vegas hasn’t posted odds on whether the Supreme Court will reject healthcare reform or let it stand. No wonder. Like everything having to do with healthcare, it’s complicated. Supreme Court watchers have come up with as many as five possible decisions the court might render. Here they are.
1. Upholds the law as written: The healthcare industry will continue to implement the Affordable Care Act’s provisions, possibly asking Congress for some modifications. New insurance coverage, new federal spending, and whole new marketplaces will have to be created at lightning speed.
2. Strikes the individual mandate: The act, as written, rests on two interconnected provisions. It says everyone has a right to health insurance regardless of their health status (guaranteed issue) and everyone must obtain this insurance whether they want it or not (individual mandate). Working together, these two provisions increase the size of the risk pool and give it balance. Leaving guaranteed issue in place without the individual mandate will cause an imbalance in the risk pool and health insurance premiums likely will skyrocket. Some call this the doomsday scenario. A number of lawsuits contesting this ruling would likely be filed all across the nation. The healthcare industry would probably ask Congress for redress.
3. Strikes the individual mandate, buts lets other market reforms, such as guaranteed issue, stand: Much the same as scenario one. Implementation continues, with possible requests for Congress to make some modifications.
4. Strikes all of Title 1: Title 1 of the Affordable Care Act includes most of the market reforms, such as the individual mandate and guaranteed issue, but excludes the insurance industry tax, Medicaid expansion and Medicare cuts. If Title 1 was stricken from the law, the health insurance industry would likely ask Congress to remove or modify the taxes and fees that remain. They would amount to over $65 million in 2014 for Blue Cross and Blue Shield of Louisiana alone, and likely would have a serious effect on premiums.
5. Strikes down the entire law: It is likely further reforms would take place at the local level, possibly through market-based exchanges, and that Congress might seek less expansive, more targeted legislative solutions.
Regardless of how the Supreme Court rules, we in the industry will take the necessary steps to increase the quality of healthcare and make it more affordable. While there could be major repercussions from some possible rulings, there is a new dynamic in healthcare today, and a willingness to collaborate and innovate that was jump-started by federal healthcare reform. This will continue to grow regardless of laws and regulations.