By Wendy Wolf and Morgan Hynd
Published on Health Affairs
Most health foundations in states with federally facilitated health insurance marketplaces breathed a collective sigh of relief after the King v. Burwell Supreme Court ruling, which retained the availability of federal subsidies for health insurance coverage. In Maine, where 89 percent of people in Marketplace plans qualified for subsidies, this ruling ensures that individuals and families can keep affordable health plans and promotes stability in our private insurance market—at least in the short term.
As King v. Burwell recedes in the rear-view mirror, health funders need to focus our collective attention on the next set of fundamental threats to the Affordable Care Act’s (ACA’s) nascent successes.
We regularly hear about the frustration and heartbreak when navigators find the person they’re helping falls below the income threshold for the ACA subsidy. Every day, they cope with the tears and shattered hopes of lower-income people whose only option for affordable coverage is through Medicaid. National and local funders need to support robust advocacy efforts and policy research that motivates businesses, hospitals, and public officials to support Medicaid expansion in every state.
This is the very scenario that fueled the rapid growth in health care costs and in insurance premiums prior to the ACA. As long as sizeable numbers of people fall into the coverage gap, upward pressure on costs will continue this cost-shifting phenomenon that drives higher and higher insurance premiums.
And some of the better strategies within the ACA to rein in costs, such as the establishment of the Independent Payment Advisory Board (IPAB), have been continually assailed by groups, including the American Medical Association and some members of Congress. MeHAF, the Blue Cross and Blue Shield of Massachusetts Foundation , the Robert Wood Johnson Foundation , and the Commonwealth Fund are just a few of the health funders that have stepped up to the plate to work with public and private partners to advocate for payment reforms that can promote transparency, contain costs, and rationalize health care spending. This issue, in our view, is the most important linchpin to the ACA’s eventual success or failure.
There’s no question that the ACA has been a game-changer in expanding access to affordable coverage and care for millions of Americans. But we’ve got a long way to go before we fundamentally transform our health care system to one that provides universal coverage and meets the Triple Aim of improving population health, enhancing the experience and outcomes for the patient, and reducing per capita cost.
The hourglass to control payment and costs is running out. Are health foundations up to the task?
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