By Ray Birch
ATLANTA—If the ruling to strike down the Affordable Care Act stands, credit unions and other employers can expect healthcare “landscapes” that vary by state and potentially offer more choice, says one healthcare industry analyst.
Moreover, the same health benefits expert told CUToday.info health insurance exchanges, once considered a potentially big opportunity for credit unions to add a new line of business, will likely go by the wayside should the ruling stand after what is expected to be a long journey to a potential Supreme Court review.
A federal court judge in Texas struck down the entire Affordable Care Act, also known as Obamacare, on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it.
“There will certainly be groups appealing the decision,” said Annette Bechtold, SVP of regulatory affairs and reform initiatives at health benefits advisory firm One Digital. “Assuming it gets to the Supreme Court, which is a good assumption, it will be interesting to see what they’ll do. The bench looks different from last time they decided on the constitutionality of the individual mandate. However, there are a number judges that were part of the original decisions whose words are reiterated back in this latest decision.”
No ‘Screeching Halt’
If the ruling stands, the Affordable Care Act, known to most as Obamacare, will come to an end, said Bechtold, noting, however, it will not be a “screeching halt.”
“I anticipate the ruling will set prospective end dates,” said Bechtold. “With some breathing space Congress has an opportunity to pass new legislation to potentially preserve some of the best features of the ACA. Likewise, states have an opportunity to take a more active role to add and modify legislation and regulations in their states to achieve good outcomes. There will be a lot in flux, but with change can come opportunity.”
Bechtold said it is difficult to predict how small employers, including many credit unions, will be affected by the end of the ACA.
“Would there be changes ahead? Absolutely. Contemplating how it might look is difficult, because the outcome hinges not only on the elimination of the ACA and its timing, but the future actions of both the federal and state legislative and regulatory bodies,” she said. “As we’ve already seen, one size doesn’t fit all, so I anticipate we may see a lot of different landscapes as states customize laws for their constituents.”
Exchanges May Remain
But Bechtold does believe health insurance exchanges, which never achieved the consumer its proponents had projected and which also never developed into a significant business opportunity for credit unions, will go away.
“I think exchanges may be phased out in how they’re used today,” said Bechtold. “However, the states may be able to repurpose the platform, or a portion of it, for other consumer engagement initiatives.”
While Democrats challenge Republicans to deliver a replacement for Obamacare if it is repealed, Bechtold said that scenario is a misnomer.
“There was no universal healthcare law previously,” she reminded. “There is nothing to say that it has to be replaced. However, there are benefits that consumers have now enjoyed that would be difficult to remove. Also, there are good working components that may not make sense to dismantle, so perhaps these are perpetuated through another initiative, law or regulation.”
With Republicans chipping away at the edges of the ACA ever since the Trump Administration took office, there has been confusion in the healthcare marketplace as insurers remained uncertain about the future, analysts have noted.
Potentially More Options
But Bechtold said if Obamacare is repealed, employers, such as credit unions, will see more options.’
“I think there will be more choice in the marketplace and options at all different price points to fit consumer needs,” she said. “For the highest-risk individuals, the outcome for them will depend on what happens to the federal dollars currently subsidizing insurance premiums for low-income individuals. Do these get repurposed to the states? How might this work? If structured properly, it could be an improvement on the markets that exist today from both a coverage and cost standpoint. Again, there are a whole host of unknowns.”
Bechtold added that she has addressed an “all-or-nothing scenario”—the ACA either continues to stand or is struck down.
“What if a final ruling finds only some portion of the ACA, namely the individual mandate, is unconstitutional? That could have a slower impact to the marketplace,” she said.