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BUSINESS OF
MEDICINE
Prior to the ruling, the lawmakers who drafted the law said there decline would occur because some people will get insurance through
was never meant to be a demarcation for subsidies for those who new employment; others will marry and go on their spouses’ cov-
purchased insurance on state-run exchanges versus the federal mar- erage; and some may not be able to pay their premiums.
ketplace. Former New Mexico Democrat Sen. Jeff Bingaman
chalked the controversial four words up to an oversight, or “it would Now that SCOTUS has ruled, she said she looks forward to
have been deleted, because it contradicted the main purpose of the building on the five-year-old program’s progress by continuing to
legislation.” expand Medicaid, making benefits available to additional low-in-
come people.
Speculation was that the decision as to this aspect of Obamacare
could put Republicans in a bind in the run-up to the 2016 U.S. EFFECTS ON HEALTHCARE SINCE ACA PASSED
presidential election if SCOTUS upended the part of the law de- In an article by Dina Overland, dated April 17, 2015, she iden-
signed to make healthcare accessible to all Americans, leaving about
6.4 million people without health coverage. Republicans have crit- tifies that it is good to be an insurer in a state that expanded Med-
icized ACA as a bloated, big-government solution and objected to icaid. The reason is that expansion states lowered their uninsured
its mandate (basis for the first Supreme Court challenge) requiring rate by more than 50 percent, compared to 30 percent in non-ex-
insurance coverage. Yet, some 16 million Americans have acquired pansion states (Texas did not expand Medicaid.) A survey by the
health coverage under the law. Robert Wood Johnson Foundation found that the ACA has de-
creased the uninsured rate by 15 million people total in the last two
The Congressional Budget Office (CBO) stated, “Repealing the years, dropping the nation’s uninsured rate to just about 10 percent.
ACA would increase the federal deficit by $137 billion or more over
the next 10 years and would increase the number of uninsured This ongoing shrinkage of the uninsured population, according
Americans by 19 million in 2016.” These projections are the first to the Government Accountability Office, is a direct result of the
official score of full Obamacare repeal since 2012. Their report fur- subsidies made available to millions of people who couldn’t afford
ther projects that in later years, about 50 million nonelderly Amer- coverage. This impact was particularly pronounced for groups with
icans would be uninsured starting in 2020 and onward. Earlier this high levels of un-insurance before the ACA, young adults and His-
year the CBO estimated that there are about 35 million uninsured panics. The young adults who were insured grew almost 10 per-
Americans, and the number should drop to 24 million by 2020 centage points, compared with 6 points for older adults.
under the ACA. The CBO report admits that these projections are Meanwhile, Hispanic adults had an almost 15 percentage point in-
based on a repeal taking effect on Jan. 1, 2016, but does not account crease, whereas nonwhite, non-Hispanic adults had a 9 percentage
for any alternative healthcare policy being passed to take its place. point growth. According to the survey, Hispanics are the most un-
A final word of clarity by the CBO: “The overall effect is difficult derserved by both insurers and providers. Another recent study
to project, given the complexity of the law and the difficulty in pro- from the Commonwealth Fund shows that 70 percent of people
jecting economic effects so far into the future.” with medical debt say the bills are from times when they had insur-
ance. This dynamic may be further explained by the fact that one-
In a 6-3 decision June 26, the Supreme Court ruled in favor of quarter of people with health insurance are paying so much in
the administration and helped to save the controversial healthcare deductibles and out-of-pocket expenses, that they are considered
law. The ruling holds that the ACA’s federal tax credits for eligible “underinsured”. So even with millions more people insured there
Americans is applicable for all 50 states. This prevented the need are some downsides, according to Wyoming Republican Sen. John
for states to act to prevent millions from losing healthcare coverage. Barrasso, “All across the county, Americans are struggling under the
So from many perspectives one can say that the real winners are the costs of healthcare, under this healthcare law (ACA).”
patients who qualify for the subsidies and who seek care because
they have insurance. Are there other aspects that make this difficult RELATED FACTORS: EHRS
to declare a winner? Yes, and I’ll mention a few. In related legislation that impacts providers and the care they
LOOKING AHEAD AFTER COURT RULING deliver, government regulators are backing down from many of
Sylvia Burwell, secretary of Health and Human Services, said she their toughest requirements for doctors’ and hospitals’ use of dig-
ital medical records. Both doctors and hospitals are required to
expected enrollment in both the state and federal health insurance have electronic health records (EHRs) to meet quality provisions
exchanges established under the 2010 ACA to decline from 10.2 of Obamacare. The original intent was by having EHRs doctors
million currently to 9.1 million by the end of 2015. She said the could exchange information about patients they share, which
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