By Simon F. Haeder
We are approaching the 10th anniversary of the signing of the Affordable Care Act. Yet once more, the prospects of the Obama administration’s signature achievement remain murky.
While a federal appeals court recently sided with a lower level judge in declaring the ACA’s individual mandate unconstitutional, it failed to fully specify what that will exactly mean for the future of the law. Unquestionably, down the road, the ACA will make another prime time appearance before the Supreme Court. Whether all or parts of the ACA will fall remains utterly unpredictable.
The stakes are high, particularly for a state like Pennsylvania, which has disproportionately benefitted from the ACA’s many provisions. Hundreds of thousands in or near poverty gained in insurance. Seniors saw their Medicare Part D donut hole filled.
Providers, particularly those in rural areas, experienced fewer unpaid bills. All of us gained important protections and benefits including free preventive services and guaranteed access to insurance coverage. The list is long. Despite its limitations, we are all better off for it.
With the lawsuit’s outcome in the balance, there is no time to waste for Pennsylvania. The state’s leaders should act quickly and decisively to insulate the state from some of the worst fallout from a potential demise of the ACA.
For the time being, Pennsylvania would be well served to maximize ACA enrollment in Medicaid and the insurance marketplace. Taking over from the federal portal healthcare.gov is a good first step.
But it is not enough.
The state needs a coordinated outreach and enrollment effort to enroll everyone eligible for coverage. Identifying and facilitating enrollment of eligible individuals across all public assistance programs makes a lot of sense, too. As does utilizing state income tax returns to target potential enrollees. Not only would thousands of Pennsylvanians gain coverage, but most of it would be funded by the federal government.
Now is also the time to expand coverage for Pennsylvania’s children. Roughly 4 percent of them remain uninsured today. We must to better. One sure way to do so is to maximize eligibility in the Children’s Health Insurance Program (CHIP).
Other states have shown that better results are possible. Massachusetts, for example, is down to 1 percent. Crucially, the CHIP expansion would survive even if the ACA is struck down.
Although more challenging politically, the state should also consider expanding coverage to children who cannot prove legal residency. Compassion for the children of our neighbors should not depend on the documents parents can produce.
Safety net providers like Federally Qualified Health Centers (FQHCs) and school-based health centers (SBHCs) provide access to many of Pennsylvania’s most vulnerable populations. They also did so before the ACA passed. Importantly, they are very cost-effective while providing high quality care. Yet they are almost always operating on tight budgets.
Targeted grant programs to encourage expansion of locations, hours, and services now allows them to ramp up access before a potential large influx of Pennsylvania’s losing health insurance. Even if the ACA remains in place, Pennsylvania will benefit from expanded access to services.
Finally, Pennsylvania should start thinking about alternatives to the ACA. While no state will be able to generate the funding needed to provide similar amounts of coverage, certain steps can be taken to mitigate some of the effects.
They include bringing together diverse stakeholders to open a constructive dialogue to discuss our options. The state’s excellent universities should be heavily involved in this process.
But there are also concrete steps to take now, such as setting up rudimentary infrastructure for a high-risk insurance pool. Standardizing financial assistance and charity expectations for medical providers should also be high on the list. All these things take time to develop. We should not wait until the last minute.
For now, the ACA remains the law of the land. It has become increasingly popular and is now supported by a majority of Americans. Indeed, many of its key provisions are overwhelmingly endorsed by more than two thirds of the population. And Pennsylvanians of all walks of life have mightily benefited from it.
Yet with large amounts of uncertainty about its viability, waiting for the outcome of a highly politicized lawsuit seems exceedingly foolish. It is time for both parties to come together in Harrisburg to start looking ahead now before it’s too late.
Simon F. Haeder is an assistant professor of Public Policy at The Pennsylvania State University’s School of Public Policy. He is also a fellow in the Interdisciplinary Research Leaders Program, a national leadership development program supported by the Robert Wood Johnson Foundation. His work appears frequently on the Capital-Star’s Commentary Page.
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