Obamacare Survives Lawsuit, but Balances on Divided Opinion

Subsidies: At the heart and extension of Obamacare

obamacare-logoThe most recent SCOTUS vote on Obamacare effectively highlights the political obstacles faced by the health care provision; from the days Congress sat on it to the future where its opponents would attempt reforms. Even though the 6-3 vote in favor of President Barack Obama’s most famous legacy cements it well into the next administration’s mandate and cannot be easily overturned, the Supreme Court debate that followed the vote throws up the liberal muscling it took to pass Obamacare into law. SC naysayer Justice Antonin Scalia had gone as far as suggesting calling the law SCOTUS care instead, which could easily be interpreted as a jab to the partiality of the judicial branch. The ensuing debate also signals the long stretch of quibbling that the law had to endure to survive, although this is not surprising considering how the Affordable Care Act (ACA) rests on Democrat principles.

Banter aside, Obamacare has always toed the clear lines of division between Republicans and Democrats. At the very heart of the SCOTUS ruling last month are subsidies which prop up Healthcare.gov. The latter is the federal health insurance exchange that will allow citizens from 34 states without insurance exchanges to avail affordable private health insurance plans, qualify for subsidies depending on income capacity, or be eligible for Medicaid. President Obama has envisioned his health care package as a universalization of health care in America with underlying population health care principals for effective delivery to all demographics. And while citizens will still be shopping private insurance plans, at the moment nothing better than subsidies could embody the state’s intent to spread out health care affordability, even across low-income populations.

Intention, however, can be easily eaten up by the economics of health care. Critics argue that subsidies in a state marketplace for insurance policies will still bend to market forces. Premiums could remain unaffordable, as some insurance companies are counting on rate increases by 2016, according to this CNBC report. Furthermore, some of the citizenry will remain unsubsidized but will have to face health care taxation. There is risk that the Affordable Care Act could also be an instrument of care iniquity, but that could be a drastic foretelling as SCOTUS upholds the legality of subsidies, which constitute a mere pre-requisite in implementing Obamacare.

The Affordable Care Act (ACA): The Fine Print Of Four Words

The Affordable Care Act’s vision of universal health care rings hollow in Republican chambers, which emphasize consumer discretion over health care concerns and their respective costs. Allowing consumers to buy insurance policies in the marketplace of their choice submits to the argued good graces of the free market, which fuel the Republican tenacity to wipe out the law as soon as President Obama leaves office in 2017. Its forcible nature is one thing that Florida Sen. Marco Rubio calls out about Obamacare, which he denounced as “bad for America.”

Prior to the ruling, challengers of ACA found a loophole in the law’s wording that would have been key to dismantling it altogether. The Congress-approved version carried the phrase “through an Exchange established by the State,” which dissenters interpreted as the exclusivity of subsidies to insurance exchanges individually established by states. This would have knocked back the umbrella purpose of Healthcare.gov to subsidize citizens of the 34 states that did not put up their own exchanges and relied on the federal one instead.

Furthermore, had the ruling gone in favor of the dissenters, concentric rounds of legal haggling would have been in order. States might be forced to come up with their own exchanges, and the uncertain transition would translate to a loss in subsidies for millions of Americans who already signed up with Healthcare.gov. Congress would have to convene for another round of legislation or rewording, which would roll back all the progress made at America’s real attempt of its own viable health care system. The end scenario of the demise of Obamacare, of course, would be the health care insurance free-for-all, presumably the other extreme of affordable care.

How Intention Won

Perhaps it is not by accident that the SCOTUS has read through the fine print and echoed the White House’s defense of ACA. Obamacare had openly envisioned universal (or at least widespread) coverage, a feature that prominent Democrats would be happy to trumpet not just in the direct aftermath of the ruling but in the upcoming elections.

No one could be more compelling about the intention of ACA than presumptive Democrat frontrunner Hillary Clinton, who tweeted her delight at the ruling and ennobled the principles of the contentious law: “SCOTUS affirms what we know is true in our hearts & under the law: Health insurance should be affordable & available to all.”

This is a blanket statement of vision that simplifies the White House’s response to ACA’s dissenters. Of course, Congress meant the subsidies to be applicable to all, that is, both federal and state exchanges, the White House said. It would seem the lawsuit’s hairsplitting falls weak in the face of proponents’ vocal and unapologetic plans on America’s inclusive health care system. The Supreme Court seems to have taken this line and integrated it into the ruling, which finally argued for the forest over the trees, as summed up by Chief Justice John G. Roberts’ written decision:

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

The statement carries a hint of good faith that challengers had openly labeled as favoritism. However, the Court’s reasoning, while resurfacing the fundamental principles of Obamacare, also begs to interpret the logic of the law’s mechanisms and implementation, regardless of Congress’ wording. If near-universal subsidies can’t be approved across all marketplaces, then Obamacare would have been self-defeating.

What Obamacare Means To The Public

Obamacare had already set in motion subsidies for millions of Americans to avail of health insurance packages, even across states that opted in on the federal marketplace. The latest lawsuit against it, called King v. Burwell, would have completely destroyed this financial support system and thrown citizens off health care insurance altogether, according to supporters.

This would have also been daunting for insurance companies, for whom the subsidies are also a form of revenue and market share. Supporters of the law argue that shooting down Obamacare would force insurers to drive their premiums up to unaffordable levels. Worse, they could stop operating in states without their own insurance exchange. Obamacare would have been good only for states such as California and Washington, which have set up their marketplace.

King v. Burwell would likely not be the last challenge to Obamacare. The Republicans have their own vision of a more publicly-attuned health care program, and if they earn the presidency in 2016, the campaign against Obamacare would likely be renewed.

How is Obamacare Changing our Healthcare system

Obamacare is essentially redirecting America towards value based healthcare using population health principles. These strategies will swiftly drive health care services through better delivery channels e.g. telehealth. As a result of Obamacare there will improved usage of technological communication lines (monitoring devices) which feed the important parts of the healthcare information system and giving patients the services they need. Some individuals and their companies participating in this massive opportunity to help hospitals and physicians change their practices economically and clinically are:

Rick is CEO of HEXL. HEXL is creating population health programs concentrated on keeping the chronically ill stable, at home and out of the hospital. Furthermore, HEXL focuses on and designs beneficial plans for telehealth, virtual health, home health care, preventative care, chronic disease management. HEXL is dedicated to improve patient outcomes and deliver various benefits, most notably, lower costs to consumers. HEXL is dedicated to change the reimbursement paradigm and create an incentive to keep people healthy. In addition, it is putting into place a solid care coordination capability to manage people who do need the services and to manage those diseases. Richard Kimball Jr. spent over two and a half decades advising healthcare organizations on strategy and capital structure and leading and building both early stage and more established businesses. Rick started at Morgan Stanley and rose to Managing Director and at Goldman he was partner. More recently he was Chief Strategy & Growth officer at Accretive Health. Rick is a Trustee of The Brookings Institution, a Fellow in Stanford University’s Distinguished Careers Institute and a member of the World President’s Organization. Rick graduated from Yale with a B.A. in Economics.

Source: hexl.com

Bruce is currently Chief Executive Officer and President at Humana Inc. Humana created Transcend, a population health management company that meets practices where they are on the path to value-based medicine. They recognize the need to simplify the procedure of population health as we work with physicians to make the transition from the traditional health care reimbursement model to value-based care. Prior to Humana Bruce Broussard was CEO of McKesson Specialty/ US Oncology Inc. At HarborDental, Bruce Broussard was CEO. Prior to that, he held a variety of roles at Regency Health Services, including Executive VP and CFO. He was also CFO at Sun Healthcare Group and VP and Treasurer at Continental Medical Systems Inc. Broussard is a Certified Public Accountant. He has a Bachelor of Business Arts from Texas A&M and a Masters in Business Administration from the University of Houston.

Source: humana.com

Steve is Chief Executive Officer at Phytel whose mission is to improve long-term health outcomes by helping physicians coordinate care and positively influence their patients’ health. Phytel provides health care organizations with proven population health technology to deliver timely, coordinated care to their patients. Before joining Phytel, Schelhammer founded Accordant Health Services, one of the country’s first disease management companies. The company grew to providing services for more than hundreds of thousands of people affected by complex chronic diseases. Schelhammer serves on the board of the American Medical Group Foundation and is an Executive Committee member of the Patient Centered Primary Care Collaborative (PCPPC). In 2000, he received the Ernst & Young Regional Entrepreneur of the Year Award for his work at Accordant. Before founding Accordant, Schelhammer served as senior vice president at Quantum Health Resources, providing specialized home care services to people affected by rare chronic diseases. He also held upper management positions with other alternate site healthcare organizations including Care Partners, Tokos Medical Corporation and Caremark.

Source: phytel.com


  1. Obamacare is looked down upon by many people, but it definitely has its advantages. If this HEXL gets up and running in the way that it should be, I think Richard Kimball will kick our medical wellness into high gear.

  2. Wow, I had no idea that Obamacare was incorporating technology to help create a more affordable way of medical care among other things. Our medical field seems to be one of the only industries that isn’t taking advantage of technology in the way that it should be.

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