Imagine an America that is no longer a union — but instead the health of individuals is determined by the state in which we live. Families in different states, neighbors across state lines, our fellow citizens are divided by available, affordable health care.
In only 16 states, individuals would have access to affordable health care options through the insurance marketplace with citizens receiving the care they need, some for the first time. However, their neighbors in the other 34 states have been forced to give up health care coverage and do without basic and lifesaving care they desperately need.
The disparity of health across our United States would be breathtaking and devastating. Unfortunately, this is a potential reality that will be decided in the U.S. Supreme Court case of King v. Burwell this month.
President Obama emphasized this in his remarks to the Catholic Health Assembly last week — America has always been bound by a set of shared values and an enduring sense that we are in this together. That America is a place where we cannot ignore the poor or turn away from the sick.
At Ascension, we serve patients at more than 1,900 sites of care in 23 states and the District of Columbia. As a result of the Patient Protection and Affordable Care Act, we are already seeing more people receiving the care they need and fewer struggling to pay for it.
In this scenario — should the Supreme Court rule against the subsidy provision of the Affordable Care Act — Ascension patients in 11 states would have better health and the care they need through access to more affordable health care. But in the other 12 states where we serve, many patients would go without — 5.5 million people.
Ultimately, the loss of more than $28 billion in federal tax credits nationwide would immediately threaten affordable health care for 9.3 million Americans and ultimately undermine the health care marketplaces, jeopardizing care for millions more.
In delivering on our Ascension mission, we are called to work toward a compassionate and just society through our actions and our words, with a special attention to those who are poor and vulnerable. This Supreme Court decision will determine the fate of health care in 34 states; we see this as the most significant policy impediment for those who are struggling to get the care they need.
The ACA is not a perfect law, but it has promoted innovations, like insurance marketplaces and accountable care organizations, that if allowed to work can expand coverage, reduce cost growth, improve quality, and ultimately create a more patient-friendly system. We are making progress.
While we are confident that the Supreme Court will protect the integrity of the ACA and the benefit it is bringing to citizens as it was intended, we must prepare for the possibility that the decision could be unfavorable. The consequences could be severe — starting as soon as August when subsidies could end almost immediately following a June ruling.
Healthy consumers are likely to stop paying for coverage without tax credits and, because most will be eligible for an affordability exemption to the individual mandate, without penalties for lack-of-coverage. Nonpayers will lose coverage quickly, as consumers generally have only a one month grace period and no continuity of care protections in nonpayment cases without tax subsidies.
Some insurers will be forced out of the market midyear, leaving providers and consumers with balanced billing and bad debt challenges. Other insurers are likely to seek large rate increases — as a result, impacting the entire individual market. A catastrophic spiral of coverage loss and premium increases will occur as a result, and in many states, destroy the individual market all together.
In order to protect our citizens, we must urge immediate action by leaders in Washington and in the states to preserve affordable coverage and prevent severe health disparity across our country. Should the Supreme Court rule unfavorably, Congress should act immediately to preserve subsidies and protect consumers — and the U.S. Department of Health and Human Services should swiftly streamline the process for establishing state-based marketplaces.
We should avoid other solutions that attempt to extend the tax credits, but really incentivize the young and healthy to leave — resulting in a more unstable and unsustainable marketplace for all.
Our nation has serious health care challenges in front of us. We need to provide better care at lower cost, make the system patient friendly rather than provider-driven, and use technology to find cures and fight disease. Let’s focus on the future rather than the past. I call on all of us to work together on solutions that unite us rather than divide us.