So, the Supreme Court upheld the federal government providing subsidies to those people enrolled in the Affordable Care Act in states that had refused to set up their own exchanges. Right now, all over the news, that’s almost all I hear. It wasn’t a close vote either, as many had predicted, believing it would be a 5-4 vote with Justice Kennedy being the swing vote (as he is in many decisions) but a 6-3 vote with Chief Justice Roberts joining the majority. My response? Meh.
I don’t think I ever gave this case more than a 30% chance of going the other way. Don’t get me wrong, it is an important decision but only in the sense of the hardship it would have imposed upon 6.4 million people (the number was estimated to be as high as 9 million). In many, if not most states, those insured would have seen their premiums double (like here in my home state) and would have forced most if not all of those same people off the insurance roll. Hey, if it comes down to putting a roof over your head and eating or paying for health insurance, which choice would you make?
As many pundits commented before today, a negative decision would have started the death spiral for the ACA. There would have been a scramble in congress to come up with some sort of fix which as we know with congress, would probably have been worse than the original.
Many are speaking today about this being a great victory for healthcare in the United States. I come back to my original response: Meh. The reason I say this is that the ACA has yet to be implemented as passed by congress. What? That’s true. Major provisions of the act (e.g., the employer mandate, taxing “premium” policies) have been delayed year over year by the president. What we do know is that it appears to be working right now but actually have to take the word of the government that it is as they won’t provide actual data since the implementation began.
Now that this hurdle has been overcome, will congress and the president tweak this system (repeal the medical device tax, open the system up for more competition within each state) or will they wipe their hands and move on?
There’ll be a lot of political posturing in the next few days and I urge you to basically ignore it from whichever side it comes from. This decision means nothing in the short term, and depending on when the act is fully implemented, even the long term.