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Obamacare's Fate: Still No Word

The Supreme Court said nothing about the Affordable Care Act this morning. The justices delivered only one opinion and it had nothing to do with health care. The most likely date for a ruling remains Monday June 25 or maybe Thursday June 28.

But a major health insurer made some news over the weekend. UnitedHealth Group announced that it will keep in place some provisions of the law, regardless of how the Court rules. Among other things, the insurers said, it will continue allowing young adults to stay on their parents' policies and it will not re-impose lifetime limits on benefits. Stephen Hemsley, the company's chief executive officer, said these provisions "are good for people's health, promote broader access to quality care and contribute to helping control rising health care costs."

He's right about that and, of course, this is good news. Executives at other major insurers have for some time been hinting they would take similar action, which means that at least a few parts of Obamacare could withstand judicial rebuke.

Meanwhile, the health care industry as a whole is in the process of reorienting itself to prioritize quality over volume, in anticipation of the law's payment reforms. There's good reason to think, as the Washington Post's Sarah Kliff observed during the spring, that the process will continue even if the law comes off the books. To understand why, check out Nina Bernstein's New York Times dispatch from Maimonides Medical Center in Brooklyn.

But these developments don't undermine the broader case for the Affordable Care Act. For one thing, as Anna Wilde Matthews notes in the Wall Street Journal, UnitedHealth is being very selective about which provisions to keep:

the company stopped short of promising to sell coverage to children regardless of pre-existing health conditions, another requirement under the law. In a release, UnitedHealth said that "one company acting alone cannot take that step, so UnitedHealthcare is committed to working with all other participants in the health care system to sustain that coverage."
UnitedHealth also didn't pledge to stick with another feature of the health law that is already in effect, the requirement that insurers spend at least 80% of premium dollars from individuals and small companies, and 85% of those from big employers, on health-related costs.

More important, the really big changes in health care are the ones that come in 2014. That's when the law makes it possible for anybody, at any age, to get insurance regardless of pre-existing conditions. That's when the law makes it possible for people making up to four times the poverty line, or about $90,000 a year for a family of four, to get subsidies if they buy coverage on their own. That's when the law makes it possible for anybody making less than 133 percent of the poverty line, or around $30,000 a year for a family of four, to enroll in Medicaid. That's when the law establishes a minimum set of benefits that all plans must eventually cover. 

These changes will mean financial security and access to health care, not just for the 25 to 30 million people slated to get coverage but for many others with inadequate coverage. But these changes will only happen if the law stays in place, because insurers can't provide them on their own.

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