Last week, the U.S. Supreme Court ruled in favor of Obamacare, finding in a 6-3 ruling that the intention of the Affordable Care Act was for residents of all U.S. states to have access to health insurance subsidies. While some DOs see the decision as a step in the right direction, others find it concerning.
“About 6.5 million patients are elated, and those of us in urban areas feel relieved,” says John Sealey, DO, a current AOA Health Policy Fellow based in Detroit, who cites the number of people who might have lost their subsidies had the court ruled against the Affordable Care Act.
A cardiothoracic surgeon, Dr. Sealey says the ACA has positively impacted patients in his community, where many hospitals were struggling previously but are now more financially viable. He hopes the ruling will encourage more holdout states to expand Medicaid.
Barbara Ross-Lee, DO, who directs the AOA’s Health Policy Fellowship program, also sees states reexamining their options now.
“There’s some data now backing up the impact of providing insurance for these populations who didn’t have insurance before,” says Dr. Ross-Lee, a vice president of health sciences and medical affairs at the New York Institute of Technology in Old Westbury, the parent school of the NYIT College of Osteopathic Medicine.
But Keith Frederick, DO, a Republican member of the Missouri House of Representatives, disagrees.
“I do not believe that the Supreme Court’s decision on the subsidies will have an effect on the decision of states to expand or not expand Medicaid,” says Dr. Frederick, an orthopedic surgeon in Rolla. Missouri has not expanded Medicaid.
Alternate paths forward
Dr. Frederick finds the ruling to be a major setback for American health care. The best way to move forward, he contends, is to repeal the law entirely. In the meantime, states can develop legislation to avoid what he calls government intrusions on health care. Potential solutions for states and physicians opposed to the ACA include facilitating the direct primary care model, in part by allowing direct primary care fees to be paid from health savings accounts and expanding the use of health savings accounts, Dr. Frederick notes.
On the flip side, Dr. Ross-Lee says she’d like to see Democrats and Republicans work together to improve the ACA.
“We all recognize that the Affordable Care Act is not a perfect reform of the health care system, but it’s certainly, based upon some of the government and Medicare reports, making a difference,” she says. “If we can start there, we can probably come up with a system that works for everybody.”