How a new Obamacare ruling could affect NC
Last month a federal appeals court ruled unconstitutional the Affordable Care Act’s individual mandate to purchase health insurance, sending the case to a lower court to consider whether to overturn the entire ACA. (The lower court previously favored this outcome.) This case will likely reach the Supreme Court after the 2020 elections. Unfortunately, the consequences of that decision could be deadly serious for North Carolinians.
The ACA is imperfect and does not resolve all of the challenges facing our healthcare system, but it is a fundamentally positive force in healthcare, expanding insurance coverage to nearly 20 million Americans. Over almost 10 years, the law has become embedded within the healthcare delivery landscape — which I see every day in my work with health systems and hospitals across the country.
Many North Carolinians rely on the ACA, and some have shared their stories in recent years. Felicia Burnett left her job and her health insurance to care for her son Ethan, who was born with a vascular tumor. Once his condition improved, Felicia could not find insurance because she had a pre-existing condition — until the ACA. Darlene Hawes lost her health insurance after her husband died, but despite heart trouble and breast cancer surgery, she obtained coverage through the ACA.
A judicial decision overturning the ACA would endanger the health and economic well-being of these and other North Carolinians.
First, hundreds of thousands of North Carolinians would lose access to health insurance. Over 500,000 obtain coverage through the state’s health insurance exchange, and since passage of the ACA the number of uninsured in our state has declined by over 30%. The law bars insurers from denying coverage to individuals with pre-existing conditions like cancer or heart disease and allows for children up to age 26 to obtain coverage under their parents’ insurance plan.
In turn, some North Carolinians would forego the care they need, increasing the chances of more severe illness and premature death. Others who seek care, but lack insurance would risk financial catastrophe. Once again, 1.7 million North Carolinians with pre-existing conditions could be denied coverage or access to essential health services. Due to increasing pressure on rural hospitals, 11 of which have closed in North Carolina since 2005, some patients might need to travel farther to receive emergency care, whether they are in labor or having a stroke.
Second, North Carolinians would lose the benefits of ACA-related initiatives that are improving quality and limiting costs. The law spurred a shift from the traditional model of healthcare financing in which providers are paid based on the volume of services they provide to payment based on the value (i.e., quality and cost) of medical care patients receive. The shift to value-based care is helping to decrease premiums in North Carolina’s health insurance exchange. In addition, the ACA has ensured easier access to generic drugs, promoted coverage for preventative services, fostered accountability around quality metrics, and expanded funding for community health centers.
Ending these reforms would worsen an already challenging situation in North Carolina, which one analysis ranks second lowest in the country for healthcare measured across metrics of cost, accessibility, and health outcomes. And it would undercut innovations by policymakers, providers and others in North Carolina that are addressing these issues.
Despite unceasing efforts to undermine it, the ACA has brought us closer to a world in which every North Carolinian has access to affordable, high quality healthcare—and in which, as taxpayers and consumers, we receive more value for our healthcare dollar. Let’s hope the courts and elected officials in Washington keep us moving toward those goals.