The U.S. Supreme Court’s ruling Thursday — that the Affordable Care Act authorizes the payment of premium subsidies in states, including Alabama, that use the federal insurance exchange — was huge for Alabamians.
There are 132,000 Alabamians who rely on the subsidies to maintain health insurance. That number is likely to double next year.
This is not a program for people who choose not to work. The subsidies do not apply to people below the poverty line. People are eligible for subsidies even if their incomes are four times the poverty level, or well above Alabama’s median income. The subsidies benefit working Alabamians whose employers do not provide health insurance.
When what now is known as Obamacare passed in 2010, the typical GOP opposition was that it would damage America’s superb health care system, a system that was the envy of the world. It did not take long for the party to realize the health care system that was superb for those with excellent insurance and no pre-existing conditions was terribly deficient for millions of Americans.
To the credit of GOP lawmakers, the opposition has changed. U.S. Rep. Robert Aderholt, R-Haleyville, trotted out the party line shortly after the court ruled Thursday.
“I think that everyone agrees that our healthcare system needed changes and improvement,” Aderholt said. “However, this was a typical bureaucratic, overreaching approach to a situation that did not need to be nearly as complicated.”
To be sure, it is complicated.
The legislation is a patchwork of compromises designed to provide needed coverage to millions of uninsured Americans while dodging the main objections of insurance and health industry lobbyists. It is far more complicated — and less effective in its goal of making sure all Americans have access to quality health care — than the universal Medicare legislation shot down by Congress during the Clinton administration.
Like any major piece of legislation, it needs changes to work efficiently. Already imperfect, its deficiencies blossomed when the U.S. Supreme Court in 2012 struck down a provision effectively requiring states to expand their Medicaid programs. For states like Alabama that rejected a Medicaid expansion, the irrational and sometimes tragic result is that people who make too much money to be on Medicaid but not enough for subsidies are left hanging.
The immediate consequence of Thursday’s Supreme Court decision is that 8.7 million Americans will keep the subsidies that make their insurance affordable.
The long-term consequences could be just as important if Alabama and the GOP-controlled Congress will quit trying to destroy the law and instead try to improve it.
A first step — one that could be taken by the state — would be to expand Medicaid and thereby eliminate the coverage gap. It’s a move that would give 300,000 Alabamians access to health care, improve the state’s labor force and revitalize hospitals.
Economists estimate the expansion, more than 90 percent of which would be paid for with federal tax dollars, would have a $20 billion economic impact on the state and create more than 30,000 jobs.
There are dozens of changes that could be made by Congress that would streamline the law and increase competition in the insurance exchanges, thus reducing premiums and taxpayer costs.
Lawmakers of both parties now recognize how desperately the nation needed health care reform. With the significant legal challenges over, it is time for them to accept the Affordable Care Act as a starting point and to begin the process of improving it.
(Published June 26, 2015)