A ruling in the latest Supreme Court challenge to the Affordable Care Act is likely this month, and local consumers, businesses and government are bracing for the potential fallout if the verdict goes against the federal health law.
The case hinges on whether a clause in the law prohibits tax subsidies for patients insured through the online federal marketplace who live in states that do not operate their own health care exchanges.
Thirty-seven states, including Georgia, declined to open and operate their own health insurance marketplace.
Thirteen states, meanwhile, set up their own exchanges, and it is believed, though not entirely clear, that individuals enrolled in these plans would not be impacted by a ruling against the ACA.
The ACA requires insurance at the risk of fines and penalties. This mandate was challenged to the Supreme Court but upheld in 5-4 vote in 2012, effectively confirming the law’s constitutionality.
The pending ruling, however, has left health care advocates, private industry and the public sector in Hall County uncertain about how to proceed.
“My first thought is about the Georgians … who will no longer have insurance due to the loss of the federal subsidy,” said Pat V. Freeman, CEO of Legacy Link, Inc., a nonprofit organization serving as the Department of Human Services’ Area Agency on Aging for Northeast Georgia that provides advocacy, programs and home-based services for seniors and their families.
A ruling against the ACA could impact more than 400,000 Georgians who bought insurance through the online federal marketplace.
More than 90 percent of Georgia enrollees in the federal exchange receive subsidies that reduce the cost of care.
Patients and consumers
A ruling against the ACA could catch many impacted individuals off guard.
“I haven’t followed this challenge near as much as the previous one only because I’ve been working so much,” said Tiffany Storey, 25, a veterinary technician from Flowery Branch.
Storey has managed several medical conditions since childhood and said that her “pre-existing” conditions limit her options and explode her costs for health insurance. Her three different medications alone would be too expensive to afford without the ACA, she said.
Individuals in Georgia must sign up through the federal exchange, Healthcare.gov, to receive subsidies based on their income to help pay their insurance premiums.
Storey said she pays only $40 a month for medical and dental coverage. Without federal subsidies, her out-of-pocket monthly expense would be around $500.
“It’s fantastic,” Storey said of the coverage she obtained through the federal exchange. “I wouldn’t be able to afford insurance if it wasn’t for it. People like me that can’t afford insurance … this is kind of our lifeline.”
Legacy Link’s Freeman said she is worried that health care costs will continue to rise beyond the means of many patients if the court ruling upends the ACA.
“Persons losing this insurance will turn back to using the emergency room for their ‘primary care’ when someone in the family is ill,” she added. “Health care costs will rise when this is the first point of treatment. And then there are persons who will not seek any treatment” until they are very ill.
The Northeast Georgia Medical Center is also preparing for what changes might result from the court’s ruling.
“We have looked at the potential impact to the (hospital) system based on the number of patient encounters we have had in the last 12 months, the number of exchange plan members in our service area and the estimated number of members who may be receiving subsidies,” said spokeswoman Melissa Tymchuk.
The medical profession has expanded widely since the ACA was passed by Congress in 2010, with several of the fastest-growing jobs in Georgia related to the industry.
Northeast Georgia just opened a new location in Braselton earlier this year.
“For plan members who are no longer able to afford to maintain their coverage and choose to cancel their insurance coverage, we will work with those patients, as we do all uninsured patients, to provide financial counseling to help them access available resources, provide charity care discounts to those who qualify and offer a discount to all self-pay patients, regardless of income,” Tymchuk said.
Business and government
The ACA has been difficult for many businesses to implement, and additional changes could generate more costs for the private sector.
“It’s been a challenge, I think, for everybody just to keep up with the new Affordable Care Act,” said Tim Evans, vice president of economic development at the Greater Hall Chamber of Commerce. “I think you’d be hard-pressed to find anybody that really understands the entire (act).”
At the very least, persistent challenges to the law are likely to continue creating confusion for businesses.
“They want to become experts in what they do, not in these other issues that they have to deal with as a small business,” Evans said.
Evans said it’s unclear to industry whether a ruling against the ACA would scrap the law in its entirety, or only the portion that pertains to subsidies.
Evans said the most “practical response at this point” is a “wait-and-see” approach.
Local government is playing the waiting game, too.
Hall County Human Resources Director Bill Moats said he will be moving forward with administration as if nothing changes until told otherwise.
Moats said he has been staying informed about the latest challenge to the ACA and how it might impact mandates for employee coverage, as well as other costs associated with new insurance fees.
For now, everything is left in limbo, Moats said.