The U.S. Supreme Court’s 6-3 decision in King v. Burwell offered a strong reminder of the primary goal of the Affordable Care Act (ACA): to improve access to affordable health coverage and care. For more than five years, the ACA has done exactly that. Before its passage, millions of people were uninsured with little hope of gaining coverage; now the uninsured rate is at an all-time low, with more than 16 million gaining coverage thanks to the law.1
The improvements the law has made don’t stop with reducing the number of uninsured. The ACA has made coverage more affordable and also more comprehensive. Before the ACA, many people had trouble affording their coverage, but now millions more individuals and families – in all states – are able to receive subsidies and cost-sharing assistance for plans they purchased through health insurance marketplaces. Before the ACA, most individual health plans didn’t provide coverage for maternity care and other key women’s health services, but now maternity coverage is guaranteed as an essential health benefit in all marketplace plans.
The ACA made this incredible progress possible, and the Court’s decision in King helps ensure that there will be even more opportunities for improvement ahead.
This is fantastic news, and our nation will be healthier, and families stronger and more economically secure, because of this ruling. However, we must continue to build upon the progress. With the threat of King behind us, policymakers should now turn their attention to key enrollment and implementation priorities. We must do more to help all consumers enroll in the health plans that best meet their health care needs and financial circumstances; access the health care services covered by their plans; and ensure that the health care system provides high quality, patient- and family-centered care.
Priorities should include:
Helping each individual and family find and enroll in the right health plan. As marketplaces prepare for the third open enrollment period, which begins on November 1, 2015, there are a number of steps they can take to help consumers enroll in the health plans that best meet their health and financial needs. This year, the National Partnership released two reports that offer specific recommendations for how to help consumers compare plans and select the ones that are best for them: Supporting Informed Decision-Making in the Health Insurance Marketplace: A Progress Report and Lessons from the Frontlines: Strategies for Supporting Informed Consumer Decision-Making in the Health Insurance Marketplace.
Specific recommendations include:
- Improve Health Insurance Literacy: Provide more opportunities for consumers to increase their health insurance literacy with tools and resources integrated into the plan selection process, and provide a checklist of information consumers should have on hand prior to shopping.
- Provide and/or Improve Key Consumer Tools: Marketplace administrators should continue developing and improving four fundamental tools that can simplify plan comparison and selection: the Summary of Benefits and Coverage template; an integrated provider directory; an integrated prescription drug directory; and an out-of-pocket cost calculator.
- Improve Plan Display: Marketplace administrators should consider how to display plan options in an order that is based on more than just the cost of the deductible. Other factors important to consumers include eligibility for cost sharing reductions, total out-of-pocket cost, and provider preferences.
- Ensure Plan Information is Accurate and Reliable: Marketplace administrators should conduct spot checks to ensure plan information, including provider and prescription drug directories, is complete, accurate and up-to-date.
Helping individuals and families meaningfully utilize their health coverage. While the ACA has helped millions purchase more affordable health insurance, additional work must be done to ensure that everyone can use their benefits to access care. This includes enforcing strong network adequacy standards, such as meaningful access to women’s health providers and Essential Community Providers; applying robust nondiscrimination provisions through strong implementation of §1557 of the ACA; and setting strong quality reporting standards that allow consumers to access quality performance information and make meaningful comparisons among plans and providers.
Supporting ongoing research and innovation to design new, improved ways to deliver and pay for patient- and family-centered health care at lower costs. When designed well, new models of delivering and paying for care can help improve patient access to appropriate and timely care; support patients, caregivers and providers in building collaborative relationships; and ensure that patients are getting the best quality care. Congress must fully fund programs like the Center for Medicare and Medicaid Innovation (CMMI), which tests new ways to pay for health care in order to improve the quality and affordability of care patients receive. The new models tested by CMMI – such as patient-centered medical homes and accountable care organizations – show promise in achieving better care, with better outcomes and lower costs, and are already impacting millions of Americans.
The King decision is certainly cause for celebration. Not only does it preserve the core mission of the ACA, it also provides a solid foundation for continuing to improve access to high-quality, better coordinated care. Continuing to build upon this law by expanding access to meaningful coverage and reforming our health care delivery system will make the ACA’s promise of quality health care for all a reality.
1 Furman, J. (2015, April 2). The Economic Benefits of the Affordable Care Act. Retrieved 7 July 2015 from https://www.whitehouse.gov/blog/2015/04/02/economic-benefits-affordable-care-act
U.S. Department of Health and Human Services. (2015, May 5). Health Insurance Coverage and the Affordable Care Act. Retrieved 7 July 2015 from http://aspe.hhs.gov/health/reports/2015/uninsured_change/ib_uninsured_change.pdf