My reaction to the Supreme Court ruling on the Affordable Care Act (ACA) was both excitement and confusion.
Legislators who oppose the ACA (including most elected officials in Missouri and Kansas) are now saying that that even if the law is constitutional, they will not takes steps to implement the law but instead work hard to defeat President Obama in the November election. If the President is defeated, it is their hope that the new President will offer legislation to repeal the current law and then potentially replace it with provisions that are more to the liking of the new President and Congress.
I cannot remember a time in my life when state legislators have overtly stated they will not implement a current federal law in hopes that the next guy who gets elected will change the law. We live in interesting times!
Missouri and Kansas legislators will have to decide by January 2013 if they want to develop a state-designed online insurance exchange, or allow the federal government to create a federally controlled insurance exchange in our states in 2014.
Also, the two state legislators will have to decide whether to take advantage of the ACA provisions of increasing the Medicaid coverage to those at the 133 percent of the poverty line. Both states currently provide coverage to folks well below this level. Most observers believe the majority of the states will take advantage of this new provision because the federal government will provide more than 90 percent of the new funding for many years.
No matter your politics, it is hard for me to understand why health is such a political issue…it should be an outcomes issue. The state of Massachusetts health reform effort which our new federal law is partially based upon has improved health outcomes in a short period of time. If we give the ACA a chance to succeed and be fully implemented, we just might see significant improvements in health outcomes for all Americans.