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Affordable Care Act’s Next Hurdles

Despite Supreme Court ruling, PPACA still faces bumpy road

In its first 5 years, the Patient Protection and Affordable Care Act (PPACA) has survived technical meltdowns, a presidential election, two Supreme Court challenges — including one resolved on June 25 — and dozens of repeal efforts in Congress. But its long-term future still isn’t ensured. Kaiser Health News has listed five of the biggest hurdles left for the health law.

Medicaid Expansion

About 4 million more Americans would gain coverage if all states expand the state and federal Medicaid programs to cover people with incomes at or slightly above the poverty line. Twenty-one states with Republican governors or GOP-controlled legislatures, including Texas and Florida, have balked, citing ideological objections, their own budget pressures, and skepticism about Washington’s long-term commitment to pay for most of the costs.

Anemic Enrollment

Eighteen million Americans who are eligible to buy insurance in federal and state marketplaces haven’t purchased it. Those marketplaces have had particular trouble enrolling Hispanics, young adults, and people who object to being told to buy insurance. Federal funding used by state marketplaces to enroll people and to advertise is drying up. Many state marketplaces haven’t figured out how to be self-sustaining. Vermont, Hawaii, Colorado, and Rhode Island are among the states searching for money.The penalty for going without coverage rises next year to $695 per adult or 2.5% of family income, whichever is larger.

Market Stability

Nationally, premiums haven’t gone up very much on average during the first 2 years of the marketplaces, but that could change. The federal government has been protecting insurers from unexpectedly high medical bills, but that cushion disappears after next year. At the same time, insurers finally have enough experience with their initial customers to figure out whether their premiums are sufficient to cover medical costs. If they’re not, the public can expect increases.


People who obtain their insurance through their employer have mostly been spared jolts from the PPACA. But the federal government begins taxing expensive health plans in 2018. The “Cadillac tax,” created by the health law, will pressure employers to offer skimpier health coverage or pass the cost on to their employees. In addition, individuals buying their insurance on the PPACA marketplaces continue to risk large out-of-pocket costs if they need lots of care. Their maximum financial obligations for next year are $6,850 for individuals and $13,700 for families. Those who choose to go out of their insurance network might have no ceiling on how much they are expected to pay.

Political Resistance

The recent Supreme Court ruling did little to diminish the GOP’s zeal to repeal the PPACA. Republicans on both sides of the Capitol have pledged to continue their efforts to kill it. A  lawsuit filed by House Republicans last year alleges that President Obama exceeded his authority when implementing the law. The topic remains grist for the 2016 presidential campaign, with several Republican presidential candidates –– including Senator Lindsey Graham of South Carolina and former Florida Governor — reiterating their desire to repeal the health law. If the Republicans capture both the White House and Congress in 2016, all bets are off over whether the PPACA survives intact.

Source: Kaiser Health News; June 26, 2015.

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