3Qs: The future of the Affordable Care Act

Kristin Madison Affordable Health Care Act
Professor Kristin Madison examines the potential outcomes of the Supreme Court’s upcoming ruling on President Obama’s signature health-care legislation. Photo by Dominick Reuter

The Supreme Court is preparing to rule on the constitutionality of President Obama’s Patient Protection and Affordable Care Act. We asked Kristin Madison, a professor with dual appointments in the School of Law and the Bouvé College of Health Sciences, to examine the potential outcomes of the Supreme Court’s upcoming ruling on his signature healthcare legislation and if our nation can come to a consensus on health care for its citizens. 

Is it possible to come to a consensus on how our government should tackle health care?

Regardless of what the Supreme Court decides, debates over our health-care system will continue and likely intensify. In the United States, there is widespread support for broad access to health care, but considerable disagreement about how to achieve it.

The fundamental challenge is that while everyone wants to ensure that people obtain the care they need, the resources that can be devoted to this goal are necessarily limited. Health-care costs are increasing all over the world, in part because of our improved ability to treat disease. We will need to have a national conversation about how best to deal with increasing health-care costs, regardless of the financing system in place.

What would it mean for the future of health care in the U.S. if the Supreme Court overturns the Affordable Care Act?

The Supreme Court is currently considering the constitutionality of two parts of the Affordable Care Act: the requirement for minimum health-insurance coverage and the expansion of Medicaid.  The impact of finding one or both provisions unconstitutional would depend on how much of the Act is struck down.  The Court could strike down just the unconstitutional provisions, for example, or it could strike down the entire statute.  Or it could do something in between, such as striking down the minimum-coverage provision and the Act’s restrictions on insurance companies.

If the Supreme Court strikes down the entire act, the number of Americans who are uninsured will likely continue to grow.  The implications for the health care system as a whole are less clear.

Congress will presumably eventually re-enact provisions of the Affordable Care Act that are essential for smooth operations of the health-care system as well as provisions that have bipartisan support.

If Congress does not act quickly, however, the result may be significant turmoil as industry stakeholders struggle to determine the impact of the Supreme Court’s decision on reforms that are already underway. Congress could respond to these challenges in many different ways, but is unlikely to enact significant legislation before the November elections.

What could we expect if the Supreme Court upholds the law?

If the Supreme Court upholds the statute, we will see about 30 million people gain insurance coverage in the next few years, mostly through Medicaid or through private insurance acquired through state “exchanges,” which are essentially centralized insurance marketplaces.  States that have delayed the creation of exchanges will need to scramble to comply with the Affordable Care Act’s deadlines.  The federal government will continue its efforts to implement the reforms mandated by the Act, including measures intended to improve health care delivery.

Ultimately, however, the actions of the Supreme Court will be less important than the actions of others in reshaping the health care system.  After all, if the Supreme Court upholds the health-care law, Congress could still repeal it; if the Supreme Court strikes down the law, Congress could re-enact it with relatively minor modifications.  And health care providers, insurers, and others will work to reform the health care system regardless of the fate of the Affordable Care Act.