Every political reporter in the country is anxiously awaiting the list of opinions from the Supreme Court every Monday and Thursday from now until the end of the month. At some point, the decision on the Affordable Care Act will come out. But that will actually not signal the fate for the law, or at least the entire fate.
UnitedHealth, one of the largest insurers in America, made the decision to retain several benefits from the law’s provisions, including allowing young people to stay on their parent’s policies until the age of 26 (which 6.6 million Americans have already taken advantage of), banning lifetime limits on benefits, making available free preventive services, and limiting rescission cases to intentional fraud (although that’s generally what insurers say now).
And many other insurers are following UnitedHealth’s lead, included Humana and Aetna. With these big insurers committed, it will be difficult for others to deny these benefits, or else they will lose market share. That’s particularly true if the smart shopping elements of the law come to pass. Many states have said they would continue to offer insurance exchanges even if the entire law were overturned.
This is not unique to insurance companies. The New York Times looked at Maimonides Medical Center and how they are preparing for a next stage of health care in America, emphasizing quality and delivery system reform:
Win, lose or draw in court, administrators said, the policies driving the federal health care law are already embedded in big cuts and new payment formulas that hospitals ignore at their peril. And even if the law is repealed after the next election, the economic pressure to care differently for more people at lower cost is irreversible.
“If the Supreme Court overturns this law — I pray it won’t — the world will go on changing,” Ms. Brier said. “In some ways, we’ve changed ahead of it.” But she added, “Trying to manage all these different aspects of the health care system as they are changing does make you crazy.”
Even if the individual mandate gets struck down, it will not unravel the law, as Pam Belluck argued. People will choose to get coverage under the regulate-and-subsidize framework, with or without a mandate.
I agree to some extent with Jon Cohn that this does not render the ACA irrelevant. UnitedHealth did not decide to keep the pre-existing condition exclusion for children, for example, or the 80-85% medical loss ratio mandated by the law. If the Supreme Court throws the whole law out, those regulations would go. And while the exchange structure could stay in place in select states, the coverage subsidies (and the Medicaid expansion) are the really important things to retain, and those hinge on the law being severable from the individual mandate, should that be found unconstitutional.
What I would say is that UnitedHealth will retain what it will because it’s extremely profitable. Their spokesman admitted to Bloomberg that the protections would add no more than “a couple of dollars” to premium costs. All of them are examples of common-sense provisions that lower costs by reducing the need for more costly care (in the case of free preventive services) or open up new markets by making insurance more attractive (the under-26 provision adds healthy people to the risk pool, for example).
Which makes you wonder why these insurance regulations a) were so hard-fought and b) were so touted as a central feature of the law. If the law wasn’t required for insurers to get on board with policies that will improve insurance and help their bottom line, then maybe the lawmakers needed to look at other options to really force their hand. Instead, they put forward choices that were both consumer-friendly and industry-friendly and called it reform.