How National Thought Leaders View The Post SCOTUS Public HIX World

By Clive Riddle, July 10, 2015

Earlier this month, Health Insurance Marketplace News published a supplemental edition of their newsletter, providing commentary from 27 ThoughtLeaders around the country at the SCOTUS King v Burwell decision. They were asked: “What’s your gut reaction to the ruling? What happens next? What challenges will Exchanges face now?”

Here’s some excerpts from key ThoughtLeaders representing major stakeholders:

First off, not everyone was pleased with the ruling. Here’s comments from Michael F Cannon, Director of Health Policy Studies, Cato Institute, Washington DC, who was considered one of the primary architects behind the lawsuit brought before SCOTUS:  “So rather than respect the democratic process and the separation of powers, Roberts allowed himself to be intimidated into rewriting the law and writing Congress out of the legislative process….What happens now is that ObamaCare opponents will continue to fight to repeal this law, because so long as it remains on the books ObamaCare will continue to threaten access to care for the sick.”

Grace-Marie Turner, President, Galen Institute, Alexandria VA, a prominent opponent and champion of consumer driven care, tells us “ People want better solutions. The only appeal to a Supreme Court decision is to the American people. Health reform -- patient-centered, consumer-focused health reform -- will be a major issue in the 2016 elections as more and more people experience firsthand the problems with ObamaCare. Change is inevitable.”

Alain C. Enthoven PhD, Marriner S. Eccles Professor of Public and Private Management (Emeritus), Knight Management Center, Stanford (CA) University, a nationally prominent and oft-quoted  figure on health policy  says the decision was “the triumph of common sense. The case should never have been brought. Obviously the intent of the law was to cover every legal resident of the USA. What’s next is to face the challenge of excess healthcare costs, which are diverting resources from meeting other important needs -- such as education, infrastructure, national security and debt reduction The ACA did very little to change the fundamental cost-increasing incentives in our system of healthcare finance. Two good places to start would be to cap the exclusion of employer contributions from employee taxable incomes at the level of efficient health plans and to convert Medicare to a premium support model, so that practically everyone would have cost-conscious choices of health plan.”

Mila Kofman JD, Executive Director, DC Health Benefit Exchange Authority, Washington DC,  actually runs a state public exchange and was of course, a happy camper: “The Supreme Court decision was important for millions of Americans who now have access to quality, affordable health coverage thanks to tax credits provided through the Affordable Care Act. I am very glad that states that use Healthcare.gov didn’t have to scramble to try to protect millions of people who would have lost access to affordable health coverage. I am relieved that millions of Americans who need premium reductions to stay covered no longer have to worry about becoming uninsured.”

Meanwhile, Simeon Schindelman, CEO, Bloom Health, Minneapolis – one of the most noteable private exchange platforms – is a little pessimistic: “The individual market needed reforming. The ACA is an incredibly expensive and complicated way to accomplish some of that reformation, but it does seem to make health insurance in the individual market accessible to many more people -- and that is a worthy outcome. I’m not judging the method, only that portion of the result. Reduction in uninsured is largely a result of Medicaid expansion and we need to be clear on that. Financial (and potentially operational) sustainability of state Exchanges, while watching insurance premium rates in the individual market over the next couple of years as the environment changes a lot, could be the next two big issues. On the former, there seems to be some pretty rough sledding coming soon and in some instances already here. On the latter, we have an abundance of speculation, but it’s an important topic.” 

From the employer perspective, JD Piro, Senior Vice President and National Practice Leader, Health and Benefits Practice, Legal Group, Aon Hewitt, Lincolnshire IL, tells us “this case was the last major judicial hurdle that the Affordable Care Act had to clear before full implementation. As a result, employers should focus on reporting on compliance with individual and employer mandates for 2016, as well as determining the impact of the excise tax in 2018. Additionally, more employers may consider a strategy of transitioning pre-65 retirees from group-based insurance to the individual public Exchange to take full advantage of the choice, competition, favorable premiums and federal subsidies.”

Larry Boress, CEO and President, Midwest Business Group on Health; Executive Director, National Association of Worksite Health Centers; Chicago, echoes the excise tax concern: “Most employers had already planned to offer health benefits prior to the decision and will stay the course to focus on how to avoid the excise tax.”

And words from the man involved at the very start – with the Commonwealth Health Insurance Connector Authority that helped inspire the ACA - Jon M Kingsdale PhD, Managing Director, Wakely Consulting Group; Visiting Lecturer on Healthcare Policy, Department of Healthcare Policy, Harvard Medical School; Former Executive Director, Commonwealth Health Insurance Connector Authority; Boston: “The 6-3 majority interpreted the ACA in the only way that makes sense, notwithstanding clear (and clearly mistaken) wording to the contrary. This is actually a ‘win’ for all interested parties, except the actual plaintiffs: It preserves coverage for 6.2 million Americans of modest income; it strengthens the law; it averts chaos in the individual insurance market in 32 states; and it allows Republicans to continue rallying their base by attacking ‘Obamacare,’ while escaping the political fallout for succeeding. Both Justice Roberts’ ruling and Justice Scalia’s overwrought dissent point to a common need -- for Congress to move beyond political posturing to constructive revision of the ACA, if only to correct poor drafting. Of course, substantive improvements are also needed, first and foremost to simplify this outrageously complex statute. However, any opportunity to do so awaits the outcome of our next national election.”