We have confidence the Affordable Care Act will be upheld in its entirety, but in case it is not, California can and must move forward with health reform regardless. The status quo in California’s health care system without reform is unsustainable. The worsening problems in our health care system won’t go away by themselves. Californians are more likely to be uninsured, more likely not to get coverage at work, more likely not to afford coverage and more likely to be denied for pre-existing conditions than residents of most other states.
If the court just strikes down the mandate and/or related provisions, those are easily fixable. For example, Congress could replace the individual mandate with a tax credit/penalty system that would be clearly constitutional under Congress’ taxing powers. However, the current Congress, particularly the GOP-controlled House, lacks the political will to make this simple fix.
Where Congress fails, California can step in. This is a fixable policy issue, which is how to attract and retain healthy people into coverage, not just the sick. The act has several provisions to prevent “adverse selection” beyond the mandate, most importantly the tax credits and subsidies to help low- and moderate-income families better afford coverage. California could put in place its own mandate and/or its own tax incentives.
Other mechanisms to prevent “adverse selection” include open enrollment periods, which encourage people to sign up at a given time of the year. With or without the mandate, Health Access has been advancing legislation, AB 714 (Atkins) and AB 792 (Bonilla), to encourage pre-enrollment and seamless enrollment and make getting coverage as easy as possible. There are a range of policy options that California can pursue after the Supreme Court decision in June, but before the legislative year is out in August, to put in place a California fix.
It’s another matter if the court strikes down the whole law, or the Medicaid expansion. This outcome would be stunning. California would lack the federal funds and the policy tools of the federal law to move forward with the same speed.
California has already been putting some policies and consumer protections in place in state law that will continue regardless of the fate of federal law, including addition of children up to age 26 on their parents’ coverage, free preventive care, and eliminating annual or lifetime caps on coverage. Health Access would work in the Legislature to salvage other consumer protections for Californians. But some of the provisions in the act are reliant on the federal funds and framework to function properly.
California would debate broad health reform, as we did before the passage of the Affordable Care Act, with proposals from an employer mandate to a universal children’s coverage proposal, to single-payer universal health care. The problems don’t go away, even if the law does.