The Supreme Court ruled in favor of the Affordable Care Act on Thursday, preserving nationwide tax subsidies to help poor and middle-class Americans retain full coverage under the exchange system. The 6-to-3 ruling saved as many as 8.2 million people from losing their health care coverage, according to a report by the Urban Institute.
Though the Obamacare ruling affects many, the complexity of the case makes its impact hard to grasp. So Ben Sommers, an assistant professor of health policy and economics at the Harvard T.H. Chan School of Public Health and one of the foremost researchers on the Affordable Care Act, took to Reddit to answer questions about what the Supreme Court decision means for the country and the consumer.
Here are the five biggest takeaways:
1. More people say the Affordable Care Act has helped rather than hurt them -- even in conservative states.
In a study published this month in Health Affairs, Sommers and his team surveyed attitudes toward the enrollment experience among low-income adults in three conservative-leaning states -- Arkansas, Kentucky and Texas. They found that far more health care applicants felt positively about the law's impact: 29.6 percent of applicants from Arkansas, 40.1 percent from Kentucky and 20.5 percent from Texas felt the ACA had helped them. In comparison, only 16.8 percent of the applicants from Arkansas, 12.3 percent from Kentucky and 13.7 percent from Texas said that the ACA hurt them.
2. Overall, the Affordable Care Act is saving the U.S. money.
One of the claims most frequently made by Obamacare opponents is that the program is expensive and will add to the federal deficit. This is only half true, Sommers told Redditors: While it costs billions of dollars to pay for new insurance coverage plans, the ACA offsets this new spending with both revenue (such as taxes on high-income Americans and penalties for people who opt out of coverage) as well as spending cuts (like the reductions in what Medicare pays to private insurance plans).
"When you take all of these factors together, the Congressional Budget Office says the ACA actually reduces net federal spending (i.e. the revenues are larger than the costs)," Sommers wrote.
Indeed, a CBO report released last week found that Obamacare reduces the deficit by at least $137 billion.
3. Expanding Medicaid in every state would make the Affordable Care Act more effective.
"Right now, there's a huge gap in accessibility to health insurance," Sommers told Redditors. Currently, 19 states have not yet expanded Medicaid under the ACA, and two are still in discussions about expansion. Expanding Medicaid nationwide would help get health insurance to those who need it most and can't afford to purchase insurance on the exchange.
"Low-income adults in these states can't get covered, while subsidized insurance is available to higher income people in the same states. From a basic concern about disparities and equity in health care, this is really troubling," he said.
4. High-deductible "bronze plans" aren't perfect, but they are better than not having insurance at all.
There have been a lot of complaints about less generous ACA plans, which fall into the "bronze" and sometimes "silver" categories. They can carry deductibles upwards of $5,000 before health insurance coverage kicks in. From a personal standpoint, paying $5,000 out of pocket might be financially ruinous or downright impossible for low-income people. From a public health standpoint, however, millions of newly insured people with any form of coverage is an improvement.
"With any policy evaluation, the key question has to be, 'Compared to what?'" Sommers responded to one Redditor's question. Compared to being uninsured, "population-level surveys from the federal government and private foundations show that at the national level the ability of Americans to get the care they need and pay their medical bills has improved significantly under the ACA."
5. Households with mixed immigration statuses present a roadblock to Latino enrollment.
According the Health Affairs study, only 75.2 percent of Latino applicants were successfully enrolled in the ACA, compared with 90.7 percent of non-Latino whites, even after adjusting for taking the survey in Spanish.
Living in a mixed-immigration status household -- for example, children who are U.S. citizens living with parents who are non-citizens -- presents a unique challenge for health care applicants. They may be concerned about immigration enforcement in their household, which can lead to a "chilling effect" on Medicaid enrollment in mixed-status households.
"It's important to remember that families and households have complex arrangements, and studies suggest that immigration concerns do affect whether people sign up for coverage." Sommers wrote."For legal immigrants, they have to use a longer application to verify their legal status in the U.S., which can also reduce enrollment rates even when eligible."
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