The People Have Spoken: The ACA is Here to Stay!

As the dust settles from last week’s elections, Florida families’ path to access to real, affordable health coverage appears much straighter and smoother. That’s not to say that there won’t still be a constant supply of bumps and potholes ahead, but we are on the move toward our destination.  In particular, consider three things we know about our journey as of today that were unclear just two weeks ago:

1.       The Affordable Care Act (ACA) will remain the law of the land.

Opponents made the repeal (or at least the deactivation) of Obamacare one of their top priorities, and the effort was to start “day one” of the next session of Congress.  Repeal would have been a tall order under any circumstances, because the law is already helping so many, but recent events assure that the ACA is here to stay.

As a smaller but important victory, Florida voters resoundingly rejected Amendment 1, one of numerous long and extreme proposals the legislature placed on the ballot. Needing 60% to pass, Amendment 1’s anti-ACA pitch couldn’t even muster a majority.  Supporters and opponents alike agreed that Amendment 1 couldn’t override federal law anyway, but its passage would no doubt have been used to justify legal maneuvers to continue resisting and delaying implementation. Voters weren’t fooled, however.

2.       The worst and scariest proposals to undermine the health coverage safety net are off the table (though the very scary “fiscal cliff” still looms).

Beyond repealing the ACA, the proposals that had been on the table would have shred the existing safety net we have in place for seniors and the most vulnerable.

Specifically, we will not see Medicaid converted into a “block grant”, which would have capped federal Medicaid funding – regardless of need – and turned the program over to states to run as they saw fit. The Florida Legislature has already been hard at work trying to limit its own investment in Medicaid, and so block granting would have been a doubly sharp knife that would have ripped clean through the program.

In addition, the proposal would have ended Medicare as we know it by converting it to a premium support (i.e., voucher) program, requiring seniors to pay thousands more out-of-pocket each year to keep the level of coverage they depend on today.

It is nevertheless important to note that cuts to Medicare and  Medicaid are still a very real possibility as a lame-duck Congress tackles the “fiscal cliff” (if they do not make cuts and/or increase revenue to bring down the federal deficit, automatic cuts will kick in).

3.       Floridians will benefit from the most important parts of the ACA starting in 2014 (despite the implementation challenges ahead).

First, low- and moderate-income Floridians will have access to a Health Insurance Exchange where they can buy meaningful, affordable, quality health coverage. That coverage will be made affordable through up-front tax credits as well as subsidies that lower out-of-pocket costs. Florida will miss the deadline to set up its own Exchange for 2014, but legislators will now have a few extra months to decide whether to try to partner with the federal government to run an Exchange or leave it to the feds entirely.

The Governor and Legislature said several times that they would begin work to implement the law if certain things happened that did not derail it. Their recent interest in the Exchange is a welcome change from the previous 2½ years of hostile resistance, but the chances that Florida can successfully accelerate from a standstill to active participant by next fall seem remote.

More broadly,  insurers (in all new plans) inside and outside of the Exchange will no longer be able to deny coverage based on pre-existing medical conditions or charge consumers more based on health history or gender.

Finally, Medicaid expansion remains intact, and although the Supreme Court said that states can reject it without losing funding for their existing Medicaid programs, the pressure will be on the Legislature, especially since it will actually cost Florida more not to expand.

Make no mistake, we still face a long road ahead. But we should finally be able to take our foot off the brake pedal and our eyes off the rear-view mirror.