The Republic | azcentral.com
Marjorie Baldwin, an economist and a health-care expert at Arizona State University, answered questions from readers last week about the Supreme Court's ruling on the Affordable Care Act.
Following is a transcript of that online session, edited for space and clarity.
Question: Now that the Supreme Court has ruled in favor, is it possible to get it overturned or changed? Is it a done deal forever?
Answer: Now the debate moves to the political arena. Gov. Romney has pledged to overturn the law if he is elected; obviously President Obama would keep it.
The people have a clear choice. Chief Justice Roberts said as much in his ruling: " ... we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation's elected leaders, who can be thrown out of office if the people disagree with them."
Q: Is there any danger of our health-care plans no longer letting us insure our young adult children not in college full time?
A: The Affordable Care Act mandates that insurers allow parents to cover young adults on their parents' health-insurance plans up to age 26. That was effective in 2010 and remains intact.
Q: So as someone who has health care through their employer, does this decision affect me, assuming I continue to get insurance through my employer?
A: Make no mistake, the Affordable Care Act, and the fact the Supreme Court has upheld it, will affect us all. The act greatly expands access to health insurance, which is clearly a good thing. But when people have health-insurance coverage, they consume more health-care services, which will drive up the costs of health care, and health insurance, for everyone. You can expect the costs of health care to increase even more rapidly than without the law.
Q: Can the state of Arizona opt out of the plan?
A: The Supreme Court ruling made it possible for Arizona to opt out of the expansion of its Medicaid program without losing all its Medicaid funding. But the state cannot opt out of other provisions of the law. For example, states must form an insurance exchange where small employers and individuals not covered by employer plans can purchase health insurance.
Q: What is going to keep the health-insurance companies from raising their premiums so high that the lower- and average-income individual will not be able to comply with the mandate?
A: The health-insurance market is competitive. If an insurer raises its premiums so that it is making exorbitant profits, other companies can undercut its premiums and take its business away. But in addition to market forces, the Affordable Care Act requires that 80 to 85 percent of an insurers' revenues go to providing quality health services to the people it insures. Administrative costs and profits are limited to 15 to 20 percent.
Q: How will services for those on Medicare be affected?
A: The act has several provisions that will effectively reduce the payments health providers receive for providing care to Medicare patients. This may cause some providers to stop seeing Medicare patients (because the payments do not cover their costs), so some Medicare patients may have a more difficult time finding a doctor. On the other hand, the act has provisions that will encourage hospitals to reduce re-admissions and reduce the number of infections acquired in the hospital. These provisions are designed to improve the quality of care for all patients.
Q: So, does this mean I can get cheap insurance for my minor child?
A: If you are having difficulty finding affordable insurance for your child now, it may become easier and more affordable through the State Health Insurance Exchange. Federal funding to help states establish the exchange is available now through 2015.
Q: Exactly how are they going to ensure that everybody abides by the law? How will they regulate this?
A: The Department of Health and Human Services has responsibility for writing the regulations that determine precisely how the law will be implemented. Enforcement is divided among a number of agencies; for example, the Internal Revenue Service will enforce the individual mandate.
Q: What is the likelihood that many states like Arizona will opt out of expanding Medicaid and thereby increase costs at the federal level? Is there a good enough incentive for states like Arizona to expand?
A: The federal government will finance 100 percent of the costs of expanding a state's Medicaid coverage from 2014 to 2016, gradually reducing to 90 percent in 2020 and subsequent years. This sounds like a strong incentive, but a state may incur administrative costs in expanding coverage that are not reimbursed, and the federal government could reduce the rate of cost sharing at any time, leaving the states to cover a greater share of the expanded coverage. Some states may be reluctant to assume that risk.