The Supreme Court on Thursday upheld nationwide tax subsidies supporting President Barack Obama’s Affordable Care Act, according to the Associated Press.
In a 6-3 ruling, the justices said the subsidies 8.7 million people receive to make insurance affordable do not depend on where they live. Roughly 200,000 Missourians will continue to receive tax credits to offset the cost of insurance coverage because of the ruling, according to the Associated Press.
The Supreme Court’s decision impacts local residents’ access to health insurance.
Lisa Church, executive director of communications and the Foundation at Bothwell Regional Health Center, said Bothwell officials are pleased with the Supreme Court’s decision.
“Without those subsidies, a lot of people are going to be without coverage that they really need to access the health care they really need,” she said.
Church said that oftentimes, when someone doesn’t have access to health insurance, then that means they don’t have access to health care.
“They may put off having preventive care or check ups or put off having diagnostic tests that they need to have,” she said. “And when they do that, sometimes the health condition gets worse and then the cost of the type of care that they need to be given is obviously more involved, and that also drives up the cost.”
Church said the health care delivery system was and is broken because the cost of health care is high and too many people can’t afford it and, therefore, don’t have access to health care. The Affordable Care Act is trying to improve that access and help those people who weren’t able to have health coverage to get that coverage.
“Now you can debate all day long whether it’s going about that in the right way and you’re going to get a lot of different opinions,” she said. “Our perspective is this: Congress passed it, the president signed it, the Supreme Court upheld it. Right now, it’s the law, so we have to do those things that we are required to do.”
Church said the Bothwell staff is working hard on the number of things required by the Affordable Care Act, such as implementing electronic medical records, improving the expected quality standards and recruiting more physicians.
Since January 2014, Bothwell offered medical services to almost 1,000 locals who are on the subsidized health care plans that were offered through the health care exchange. Church said without that program, people who obviously do not qualify for Medicaid, wouldn’t have access to any health coverage.
Church said the subsidized plans made a huge difference to Bothwell staff because those 996 people who couldn’t have health coverage through Medicaid may not have received the health care they needed.
The State of Missouri hasn’t reformed or expanded Medicaid in more than a decade, according to a Medicaid fact sheet released May 26 by the Department of Health and Human Services. Church said the only thing missing in the picture is this lack of Medicaid reform or expansion.
“The whole system was based on extending that Medicaid coverage,” she said. “Hospitals are seeing significant a decrease in reimbursements. From 2012 to 2019, we’re projecting that we will lose $35 million in reimbursements because of the Affordable Care Act. What was supposed to help counteract that was the expansion of Medicaid so that more people had access to coverage through the Medicaid system.”
Medicaid is designed to cover services such as doctor’s visits, prescription drugs and preventive care, and also helps seniors and people with disabilities receive long-term services and support in their communities and in nursing homes, according to the government’s Medicaid website. Church said users of Medicaid are often thrown into a stereotype that doesn’t reflect the true nature of those who use the Medicaid system.
“People like to use that stereotype that Medicaid is someone who doesn’t have a job or doesn’t intend to get a job, but in actuality, oftentimes the people who would receive Medicaid if it were expanding in Missouri are the working poor,” Church said. “They’re the people who perhaps have minimum-wage jobs or cobbled together multiple part-time jobs, and those jobs don’t have access to health care coverage.”
Church said Bothwell has seen an increase in its physician clinic visits, and it had a slight dip in emergency department volume in the past fiscal year.
Keith Sumner, co-owner of Sumner Insurance Services in Sedalia, said health care providers and others in the insurance field across the board have been waiting in suspense for the Supreme Court’s decision.
“We’re out of the enrollment period, but things have been on hold a bit waiting for this decision,” he said. “Since the subsidies were upheld, we’re going forward with the special enrollment situations as we come across those but the big thing that looms out there is the employer-employee mandates that are coming ahead.”
There are individual health care plans and there are group health care plans offered in the Marketplace, and Sumner said the group plans have been delayed for the most part.
“There’s a lot of change ahead.”
Sumner said that of the Missourians who applied for health insurance in the Marketplace, 80 percent have qualified for tax subsidies so far, which offsets a good share of their premium.
“So for those folks, a significant percentage of those, it has been more affordable health care for them,” he said. “But for some of those and the ones with no subsidies, costs are actually increasing. Depending on income and all kinds of scenarios that factor into it, it comes down to whether a person is getting a sizable subsidy or not.”
Sumner said they’ve seen increases in the number of locals signing up for health insurance, between 20 and 25 percent that have come into the system. However, he said, the changes don’t stop here.
“The president and many supporters of the Affordable Care Act want to take this decision now and basically proclaim that it is in fact all settled and we’re all good to go,” he said. “But in reality, every month we see continuing changes, continuing different interpretations of different areas of the law.
“There will be a lot more disagreements and struggles among providers, insurance companies and insured ahead.”