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A quick guide to covering the Supreme Court ruling on health reform

 

 

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AHCJ is committed to helping you cover this milestone decision. For many valuable tips and resources, visit our health reform topic pages, compiled by health reform topic leader Joanne Kenen.

By Joanne Kenen

This story will have many dimensions – policy and political – to keep us busy for months to come but here’s a quick guide to help you get started in reporting the ruling’s impact on your community.

Also on Twitter, you can look for #SCOTUS (shorthand for Supreme Court of the United States) #hcr (health care reform) and #aca (Affordable Care Act). There will be others but those three will keep you busy.

The ruling is expected on Thursday, June 28. It will be handed down live, from the bench, in sessions that begin at 10 a.m. ET.  The ruling will go up on the court website fairly quickly, and many news organizations will post as well. As most of you know, there is no TV or radio feed, and reporters can’t have cell phones or laptops in the courtroom.

For a quick refresher on what provisions of the law are already in place – and which are to go into effect in the coming years, here’s the government timeline.

A lot of the recent attention has been on the policies that went into effect in September 2010, including letting young adults stay on parents’ health plans. This is relatively small compared to the overall law – but with its provision already in effect, there are benefits people are already getting that they could lose, so it’s in the spotlight.

The main scenarios for the court:

  1. Uphold the whole law.

    Conventional wisdom: Longshot

  2. Overturn the whole law.

    Conventional wisdom: Maybe

  3. Rule the individual mandate unconstitutional.
    Conventional wisdom:  Likely.  The court could either throw out only the mandate, or throw it out along with two closely-related new health insurance rules called guaranteed issue (covering pre-existing conditions – people who are or have been sick or injured) and community rating (limits on what insurers could charge older versus younger people). The coverage of pre-existing conditions is very popular and a lot of your local reaction/coverage may well involve this provision. We have written several posts on the mandate and the rules. Here are two recent ones:

  4. Strike the Medicaid expansion.
    Conventional wisdom: Not all that likely. If the court wants to get rid of both the mandate and Medicaid, it’s more likely to just throw out the whole law, not these two big pieces.

  5. The final possibility – that under an obscure tax law the Court will decide it has no authority to rule until people actually pay the penalty for ignoring the mandate in 2015.
    Conventional wisdom:  So remote that most of us have stopped writing about it.

Some questions to ask and angles to pursue:

If the whole law is overturned …

What’s going to happen to the popular provisions already in effect – covering young adults on parents plans until age 26, end of lifetime limits, ban on denying coverage to children because of pre-existing conditions.

Some of the big insurers have said they will keep the young adult coverage (already priced into current policies). Not all have. Some have already gotten rid of the lifetime limits, again, not all. The coverage for ill children is precarious – uncertain how many carriers will do so, and in what markets. (If only the mandate is scrapped, these coverage provisions would be unaffected.)

What will happen to Medicare beneficiaries who had been getting extra help with drug costs and more free preventive care?

Who would have gotten funding that they won’t get now?

Medicaid primary care doctors (who would have gotten Medicare rates temporarily), community health centers, safety net hospitals would have had fewer uninsured patients

What happens to Medicaid without the expansion? Is the state going to build on any of the preparation work (including IT systems for enrollment and verification) that it had been doing? Will it expand any benefits or cover any new populations. OR – and this is important – now that states are no longer bound by “maintenance of effort” rules in the Affordable Care Act, will they start cutting beneficiaries or benefits to fill budget gaps? Or will they do it subtly by making it harder to enroll and stay enrolled. (Talk to advocates about this.)

What happens to people in the federal high-risk pools? Does the state have a plan for them? This applies too if the mandate and the guaranteed issue rule is struck. What happens to these high-risk people who insurers don’t want to cover? Will they get rolled into the state high-risk pools (in those states that have them)?  Does the state have money for that? The federal law had  $5 billion for this hard-to-cover population, and that will dry up.

If the law is upheld all or in part:

Is your state ready to run an exchange (on its own, or in a partnership with the federal government)? Will it be ready by next November (one of the Center for Consumer Information and Insurance Oversight’s deadlines)?

If not, is the state starting to get ready? Is the legislature going to be in session between now and then – if not, how will they catch up?

Or if they aren’t ready – and are opposed to the health law – will SCOTUS make them start preparing? Or are they now going to say the future is still too uncertain – ask us after the elections.

If the mandate is struck but Medicaid expansion, exchanges and subsidies go ahead:

Will the state consider any alternatives to the mandate? Things like auto-enrollment, penalties, open season, tax credits, etc.

What plans did hospitals and health systems have for covering the uninsured – and now what happens?

Are doctors more or less likely to change how many Medicare/Medicaid patients they see?  Have they had lots of patients who became uninsured during the recession – what’s go into happen to them now?

Questions about the delivery system:

Depending on the scope of the ruling, various programs and incentives may or may not still be around (and we may not know immediately which, if any, Medicare can find ways of continuing). These include the Center for Consumer Information and Insurance Oversight’s innovator programs, Partnership for Patients, readmission reduction programs, etc. Will the hospitals and health plans and payers find ways of continuing these programs?  Even if these specific programs fall aside, what other innovations and pilot programs and ACO-like arrangements will continue with  private sector or state backing in your community?

Had doctors in your community begun planning for new delivery system models? Will that go forward in conjunction with local hospitals and health plans? Or is it status quo?

It may not be immediately clear exactly what happens to some of the innovations started up under the health law – including Accountable Care Organizations. They may still be deemed valid, as they were funded and contracts were signed when the law was in effect. But it never hurts to ask – who is going to start suing whom over what?

Going forward

Finally – Janet Adamy of The Wall Street Journal had a good story the other day about secondary provisions in the health law – tanning salon taxes, workplace accommodation for breast-feeding, menu-labeling, etc.  You probably won’t want to write about them in the first wave of coverage, but local angles abound once you catch your post-SCOTUS breath.

Webcast: Explaining, localizing Supreme Court's health reform decision

Scheduled for noon ET on the day after the court releases its ruling.