The Patient Protection and Affordable Care Act of 2010, also known as the Affordable Care Act (ACA) and Obamacare, has remained intact for the most part since its inception. In the process of doing so, it has made it possible for millions of Americans to obtain health insurance coverage who previously lacked it. A significant feature of this legislation was a requirement that insurance companies had to allow coverage for all individuals regardless of any preexisting health conditions, which previously had led to their being denied such protection.
Along the way, there were setbacks for the law that have occurred over the decade. Seventeen months after the ACA’s enactment, the HHS Secretary announced that the Community Living Services and Supports (CLASS) Act, which was meant to address the costs of long-term care, was abandoned because it was considered unsound financially. In 2017 as part of a successful attempt to overhaul U.S. tax law aimed at energizing the economy, Congressional Republicans were able to zero out the individual mandate penalty. That occurrence led to a claim that once the mandate was stripped of its penalty for not purchasing health insurance, this provision no longer was enforceable and could not be considered as being constitutional.
An extension of that line of reasoning subsequently led to a conclusion that since this essential component of the Affordable Care Act was eliminated, then the entire law now should be struck down. Whether or not such an event will occur has yet to be resolved in the courts. ACA opponents in Congress also were successful in repealing the health insurance tax beginning in 2021, along with the so-called Cadillac tax on beneficiaries who have expensive insurance policies, and the medical device tax beginning in 2020. A problem is that revenue from these taxes was intended to cover the costs of expanding health insurance coverage under the law.
A centerpiece of the ACA was the formation of accountable care organizations (ACOs) in the Medicare program. As described in the April 2020 issue of this newsletter, results of a survey conducted that month by the National Association of ACOs (NAACOS) indicate that these entities are highly concerned about the effects of COVID-19 on their organizations. A possibility is that many respondents in risk-based models reported they are likely to quit the ACO program to avoid financial losses stemming from the pandemic. Apart from legislative and judicial battles, this example demonstrates how unfavorable economic conditions also can influence the outcome envisioned by Congress in 2010.
Medicaid Program In A Time Of COVID-19
Just as the recent pandemic has the potential to have a negative impact on the Affordable Care Act, it also can result in positive developments. An example involves the federal-state Medicaid program, which is considered to be countercyclical in nature. When the economy heads south, which it did quite dramatically causing millions of workers to become unemployed and advised to stay locked down in their homes. A great many of these individuals lost their health insurance coverage as a result. An option for them is to seek to enroll in Medicaid. Prior to the appearance of COVID-19, many states around the nation already were financially strapped because of an existing burden that compels them to meet rising program costs at the expense of being forced to reduce spending in other important categories, such as providing funds for higher education.
Just as health spending undergoes an increase, state income tax revenues derived from workers is decreased, along with taxes on restaurants and other venues where these employees worked and the general public patronized. Fortunately, the federal government has come to the rescue. A form of aid is represented by the Families First Coronavirus Response Act (P.L. 116-127) that authorized a 6.2% increase in the federal match rate (retroactive to January 1, 2020) available if states meet certain “maintenance of eligibility” requirements. Provisions include two weeks (up to 80 hours) of paid sick leave at the employee’s regular rate of pay when quarantined and/or experiencing COVID-19 symptoms and seeking a medical diagnosis; or the same amount of paid sick leave because an employee is unable to work because of a bona fide need to care for an individual subject to quarantine or to care for a child under the age of 18.
More May 2020 TRENDS Articles
RESEARCH AND EDUCATION AFTER THE PANDEMIC
Indicates the importance of recognizing how “confounding” as a source of bias threatens the process of causal inference in research practice. Read More
PRESIDENT’S CORNER
ASAHP President Phyllis King presents information about the Association’s five strategic objective areas and associated success measures. Read More
HEROES ACT PASSED IN HOUSE
Contains details about a proposed piece of legislation to furnish additional financial assistance to deal with economic consequences resulting from the COVID-19 pandemic. Read More
HEALTH REFORM DEVELOPMENTS
Points out how the federal-state Medicaid program is being augmented to provide insurance coverage and paid sick leave benefits for individuals negatively affected by job loss. Read More
DEVELOPMENTS IN HIGHER EDUCATION
Describes how Mad magazine’s Alfred E. Neuman’s motto of Quid Me Anxious Sum serves as a motivational factor for enjoying life once governmental lock-down provisions are relaxed and also how coronavirus stimulus funding is being distributed to colleges and universities. Read More
QUICK STAT (SHORT, TIMELY, AND TOPICAL)
Births: Provisional Data for 2019
Effects Of The COVID-19 Pandemic On Routine Pediatric Vaccine Ordering And Administration
Non-Invasive And Reversible Modulation Of Neuronal Activity To Diagnose And Treat Brain Disorders
Cracking Nature’s Most Common Chemical Bond To Improve Drug Effectiveness Read More
AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY
What COVID-19 Epidemiologic Models Can And Cannot Tell Us
Supporting Student Health And Mental Well-Being
Caregiving In The United States 2020 Read More
RETHINKING THE “BENCH” AND “BEDSIDE” DICHOTOMY
Mentions how research activities might be understood better in the context of “discovery-invention” cycles rather than a basic/applied dichotomy that translates loosely to notions of bench and bedside research. Read More
ADDRESSING THE 60-30-10 CHALLENGE
Refers to a study that discusses how 60% of health care adheres to guidelines; 30% is represented by care that is waste, duplication, or low value; and 10% accounts for iatrogenic harm or adverse events. Read More