What the ACA Decision Really Means for You

Are you ecstatic, happy, neutral, sad, or devastated about the Supreme Court’s ruling upholding almost all of the Affordable Care Act?

The answer may depend on your politics, but it more likely has everything to do with what the ruling means for you and the people you care about.

Back in March, I wrote a column entitled “How We Really Hope the Supreme Court Will Rule on the Affordable Care Act.”  Now you’ve heard pundits, politicians, and public officials tell you how to feel, let’s recap where you might really stand on the decision.

Let’s start with your policy views.

If you favor a single payer, “Medicare-for-all” program:  You’re devastated.

Your only real hope for resurrecting “Medicare for all” was if the individual mandate was thrown out.  It wasn’t.  You may have Medicaid and Medicare expansions, but over the long haul that probably won’t be enough for you. 

If you want a market-driven insurance environment, where insurers compete for your business with a minimal number of mandates and requirements:  You’re also devastated.

Neither liberals nor conservatives truly won on this one.  Like Medicare-for-all advocates, you lost your political battle to reduce the role of government in healthcare, and it may be impossible to win in the future.  

If you want to reduce the size and scope of the state Medicaid programs: You’re unhappy.

Medicaid is getting bigger, but at least the state’s not footing the bill.  Your state can refuse to expand the program, but then it’ll give up all the new federal dollars, too – and may still have to provide an alternative for poorer people who can’t afford insurance.  Maybe the federal government will take over the program in its entirety some day, but don’t hold your breath.

If you want more universal coverage, but don’t care whether it’s private or public:  You’re happy.

It may not be perfect, but the combination of Medicaid expansions, new Medicare benefits paid for by Medicare tax increases for the wealthy, and subsidized private insurance for the middle class will lead to more coverage, and fewer uninsured.

Now let’s turn to your personal views.

If you are among the 206 million people who make less than 400% of poverty (currently $91,200 for a family of four):  You’re happy.

For those who don’t have access to group coverage, you’re about to get a valuable tax credit toward what you pay for insurance.  For example:  A 45 year old with a family of four making $60,000 per year will be eligible for a tax credit of over $9,000, reducing the cost of an average family plan to around $400 per month.

If you are among the estimated 4 million people who can afford insurance, but will choose not to buy it:  You’re unhappy.

By 2016, you will be paying a new tax of $695 per person, $2085 for a family, or 2.5% of income, whichever is greater.

If you are one of the 11 million people due a premium rebate in 2012 because your insurer didn’t meet the minimum loss ratio standards:  You’re happy.

The biggest consumer protection in ACA – the minimum loss ratio – is still in place, along with all the others.  You’ll get your rebate, and your insurer will be paying out more dollars for care in the future.

You or a child of yours is one of the 133 million people with a chronic condition and, especially, one of the 4 million who is uninsurable as a result:  You’re happy.

Your child with a disability will still be covered on your insurance, and as an adult you’ve still got PCIP in the short term until full pre-existing condition relief takes effect in 2014.

You are one of 48 million Medicare recipients:  You’re ecstatic.

Your donut hole coverage and preventive services remain in effect, and will even improve in the future.

You are one of the 17 million people living below 133% of poverty (currently around $31,800 for a family of four) who don’t have insurance:  You’re happy.

Unless your state decides to refuse to expand the program as a matter of principle, in 2014 you’ll be eligible for Medicaid.

You are one of the 13 million adult children currently on your parents’ insurance:  You’re happy.

You can stay on your parents’ plan until you’re 26.

This is the second in a series of five OHPM columns on the impact of the Supreme Court decision on the Affordable Care Act. Tomorrow: the impact of the ACA decision on the future of private insurance.