Lee Lynch
The King v. Burwell Supreme Court decision – announced Thursday 6 to 3 in favor of Burwell and the Affordable Care Act (ACA) subsidies – ends the long waiting, wondering and scenario-planning period for health advocates representing patients nationwide.
The outcome of the case, which had the potential to destroy the centerpiece of the ACA and impact approximately six million Americans, ultimately means that individuals who secure health insurance through an exchange established by the federal government will be eligible for the tax subsidy created through the law. And it has many advocates saying, simply, ‘phew.’
Before media even published the Supreme Court decision online, the National Health Council (NHC) issued a statement applauding the decision. “The Affordable Care Act has proven to be an effective way of ensuring people with chronic diseases and disabilities have access to meaningful insurance coverage,” said NHC Chief Executive Officer Marc Boutin. “The Supreme Court made the right decision – a decision that will enhance coverage and improve patient access to quality health care.”
In the end, it was the easiest possible decision to which advocates could react. But the months leading up to it left them in a constant state of scenario planning. The previous Supreme Court decision relating to Obamacare – NFIB v. Sibelius – threw advocates, policy experts and just about everyone else for a loop, when the Supreme Court upheld by a vote of 5 to 4 the constitutionality of the individual health insurance mandate, however, a majority of the justices, including Chief Justice Roberts, also agreed the mandate was not a proper use of Congress's Commerce Clause or Necessary and Proper Clause powers.
The rather complicated middle-ground outcome initially led CNN and Fox News to announce the Court had struck down the mandate and it left advocates skittish about carrying out pre-education on King v. Burwell. Advocates said in pre-King v. Burwell decision interviews that, while there were a multitude of pre-decision efforts underway with NFIB v. Sibelius, really no one was out there talking with patients about the possible impact of different King v. Burwell outcome scenarios on their current healthcare coverage and future options.
According to NHC, WomenHeart and Men’s Health Network, they were preparing or were ready with messages and statements that covered various scenarios, but going beyond that felt academic. “We will carefully consider the decision and let our constituents know how it could affect them,” said WomenHeart Vice President, Public Policy Susan Campbell.
“Trying to handicap the Supreme Court decision didn’t really make sense, since the [NFIB v. Sibelius] decision was so unexpected,” said Sal Giorgianni, advisor to the Men’s Health Network and Chair-Emeritus of the Men's Health Caucus of the American Public Health Association. “And this decision wasn’t going to dramatically impact our constituents one way or another. We pressed under ACA for more favorable treatment of men, but the preventative coverage is really aimed at women.”
Caitlin Donovan, Director of Outreach and Public Affairs for the National Patient Advocate Foundation (NPAF) said they had to try to prepare for anywhere between nothing changing and everything changing. “Depending on how the decision was written, we ultimately might have had to communicate different changes to people in different states.”
Donovan said she came to realize in talking with patients over the past few months, that a lot of people still don’t understand what kind of coverage they have, so NPAF was preparing to simultaneously educate people about their current coverage they and get them information about the King v. Burwell decision that would be specifically useful to them.
But in the end, advocates are almost unanimously declaring the decision a victory for patients, and the vote was decisive enough that the scenario plans can probably stay filed away for years to come.