The election outcome and your health care: What’s next


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On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) into law. Since then, Blue Cross of Northeastern Pennsylvania (BCNEPA), other health insurers and the entire health-care industry have been working to implement the law’s numerous provisions, many of which go into effect on Jan. 1, 2014.
Since its passage, the ACA has been a polarizing issue among Americans. Legal challenges to the ACA from a number of states and small business interests resulted in the U.S. Supreme Court ruling on the constitutionality of the ACA this past June. The court ruled that the individual mandate provision and the insurance market reforms included in the law were constitutional. The court’s decision ensured that the ACA remained a cornerstone issue in this year’s presidential election.

The ACA is President Obama’s signature domestic accomplishment. Now that the president has been elected to a second term, we can expect the administration to continue moving toward full implementation of the federal health-care law over the next few years as designed.

Because a major campaign theme for many Republican candidates was a vow to repeal the ACA, many are speculating whether there will be efforts by some in the new Congress to propose changes to this wide-ranging reform law.

Whether or not these forces continue to collide, BCNEPA and other health insurers will remain on the path of ACA implementation as directed under the law and by the Obama Administration. That means that beginning on Jan. 1, 2014 consumers will be able to compare and purchase health insurance plans through an online exchange. Individuals with lower incomes will have access to federal subsidies to help pay for their coverage, and individuals with pre-existing medical conditions will not be denied coverage through the exchange.

We must also remain mindful that implementation of certain major provisions of the ACA — such as establishing health insurance exchanges and whether or not to expand Medicaid eligibility — are decisions now facing individual states.

Nov. 16 was the deadline (since extended) by which states must inform the federal government if the state is prepared to administer its own health insurance exchange or work with the federal government to jointly operate an exchange. If a state is not prepared to pursue either of these paths, then the federal government will step in and administer the exchange.

States must also decide whether or not to expand Medicaid. In its original form, the ACA compelled states to expand Medicaid eligibility to those individuals under the age of 65 who make less than 133 percent of the federal poverty level. The U.S. Supreme Court’s decision in June, however, allows states to choose to participate in this expansion, and Pennsylvania is one of many states that have not yet made this decision.

Development of a health insurance exchange and whether or not to expand Medicaid are just two of the major health-care decisions facing our Commonwealth. On these and other issues, we urge our policy makers to make decisions that retain state control of our health care and health insurance markets, because our commonwealth leaders know our markets and consumers, and are in the strongest position to decide what will work best for all Pennsylvanians.

At the end of the day, it’s important to realize that these measures — and the other insurance market reforms included in the ACA — will not address the driving issue of rising health-care costs. All stakeholders in the health-care system must continue to work toward a unified and multi-faceted approach to addressing the rising costs of care.

For example, health insurers are already working with doctors and hospitals nationwide to implement accountable-care models and other patient-centered payment reforms that reward the quality of care a patient receives. Health insurers are also offering an array of programs that promote wellness and that help manage costly chronic conditions.

As Congress and the president continue to debate health-care policy over the next few years, Blue Cross of Northeastern Pennsylvania urges lawmakers at the national level to turn attention to policies that address the long-term ability to control escalating health-care costs.

Now that the 2012 elections are over, our members — and all residents of the 13 counties we serve — deserve health-care policy at both the state and federal levels that works to control escalating costs through prevention, disease management and wellness; improves access to care; and rewards doctors and hospitals for keeping their patients healthy.

Kimberly J. Kockler is vice president of government affairs for Blue Cross of Northeastern Pennsylvania. The ideas and opinions expressed are solely the author’s and not necessarily those of the Business Journal.