Healthcare Advocates in NJ Cheer High Court’s Ruling Upholding ACA Subsidies

Andrew Kitchenman | June 26, 2015 | Health Care
Analysts say improvements needed in national health insurance law could be addressed at state level

Credit: NJTV
State Sen. Nia Gill (D-Essex)
Now that the U.S. Supreme Court had upheld the subsidies deemed crucial to the survival of the Affordable Care Act, advocates for the government-subsidized health-insurance program say individual aspects of the law need to be improved or fixed – and that some of those efforts need to be at the state level.

After expressing relief over yesterday’s high court decision, healthcare advocates said specific problems that need to be addressed include high out-of-pocket costs, the trends toward smaller insurance networks, and the lack of transparency about healthcare costs. With a divided Congress still at loggerheads over what’s come to be called “Obamacare,” they said the state may be better able to address those issues.

Chief Justice John Roberts’ 6-3 majority opinion drew praise in New Jersey health policy circles, as Roberts completely rejected the argument by subsidy opponents that the Affordable Care Act limited the tax credits to residents of states that have established their own health insurance exchanges.

New Jersey – spearheaded by Gov, Chris Christie – is one of the states that has not created its own exchange, so Garden State residents with policies acquired through the ACA would have been especially at risk of no longer being able to afford their health coverage without the subsidies.

Sen. Nia Gill (D-Essex) said she is already looking to make the case for establishing a state-based insurance exchange in the future – a change that may have to wait until ACA opponent Christie is no longer governor.

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts wrote.

Seton Hall University law professor John V. Jacobi said Roberts demonstrated a masterful knowledge of how health insurance works.

“It’s a real relief,” Jacobi said of the decision.

Rutgers Center for State Health Policy Director Joel Cantor said the decision insures that the marketplace in New Jersey will continue “on the path that we’re on. It means that our individual health insurance market will remain viable, and it means our Legislature and administration won’t have to confront 170,000 people losing their subsidies.”

New Jersey Health Care Quality Institute Vice President Linda Schwimmer said the court majority sent a message that they’re not viewing the ACA through a political or partisan lens.

Ross Honig, president of the New Jersey Association of Health Underwriters, said, “When someone walks into a doctor’s office or has a medical event, they have no idea typically of what the cost is for the actual services.”

Honig said policymakers can now focus on trying to lower healthcare costs.
“I honestly don’t think health insurance (cost) is a problem in this country — it’s the cost of care,” said Honig, whose organization includes insurance brokers, who help employers and individuals buy insurance

One way that the state could tackle the issue of costs is by requiring that patients be informed of the potential costs of services before receiving them. For example, if a patient is informed that a procedure provided by one doctor will cost $200 but would cost $100 if done by another doctor, the patient could choose the less-expensive option.

[related]Jacobi predicted that, ultimately, the federal government will have to provide more generous subsidies to make marketplace plans more affordable.

But he said that another issue requires more immediate state action – the growth of smaller, “narrow” insurance networks.

A “narrow network” – a subjective term referring to insurance networks that have fewer healthca re providers that traditional networks – is one of the major ways being used by insurers to limit costs, since they are able to negotiate lower reimbursements in return for directing large numbers of patients to providers. The “narrow networks” can also enable insurers to more closely coordinate patient care.

But Jacobi pointed out a potential pitfall – inadequate “narrow networks” can make it difficult for patients to access certain specialists. This is particularly true for behavioral healthcare, which includes both mental health and addiction services. He added that state Department of Banking and Insurance officials are aware of and sensitive to the issue.

As for establishing a state exchange in the Garden State, state Sen. Gill said New Jersey could look to Pennsylvania and Delaware as potential models. They were recently granted the ability to have state exchanges while paying the federal government for the use of the technology behind the marketplace site