Obama’s Reelection Bakes In ACA

The reelection of President Barack Obama to a second term virtually guarantees that the Patient Protection and Afforable Care Act he signed into law nearly three years ago will remain intact, with its biggest provisions and changes coming in 2014.

That has cheered policymakers who are concerned about the millions of Californians who lack health insurance, but has stoked concerns among providers that they will likely not get paid enough to care for them.

Although Democrats held the Senate and therefore would have made repealing the ACA or chipping at it through budget reconciliation unlikely, observers were concerned a Republican presidential administration would slow and even impede implementation.

Now, a dramatic expansion of the Medi-Cal program will begin to take place in 2014, along with the enrollment of more affluent Californians in the Cover California health insurance exchange, which will begin early enrollment in October 2013.

The UCLA Center for Health Policy Research and the UC Berkeley Center for Labor Research had predicted between 1.8 million and 2.7 million Californians would receive healthcare coverage when reform is fully implemented by 2019.

But Dylan A. Roby, the UCLA Center’s director of economics, believes now the state’s total number of insureds will be on the higher end – about 94% in all – due in part to Obama’s reelection.

“If President Obama hadn’t been reelected you could see a world where executive orders would have been issued to lock up grant money, where there would have been stalling on certifying the exchanges as operational,” Roby said – along with a number of other acts intended to slow implementation, he observed.

Although Roby waxed optimistic about the ACA’s implementation, more concerned is C. Duane Dauner, president of the California Hospital Association.

“Will expanding coverage be good for every community and hospital? The answer is no,” he said.

According to Dauner, hospitals are already getting clipped on rates for treating Medi-Cal patients, which are the 49th lowest among states and cover about 65% of actual costs. But he also fears that low and moderate-income people who buy insurance via the Cover California exchange could pose a financial risk for hospitals.

Should those enrollees purchase bronze or silver-level health plans – lower price products with commensurate levels of coverage – Dauner thinks uncompensated care costs for hospitals could rise.

“The bronze plans covers 60% of cost, and silver covers 70%,” Dauner observed, noting that the rest of the cost comes out of the pocket of the patient and could “be bad debt for the hospitals.”

As a result of these concerns, Dauner said the CHA and hospital lobbies in other states – about a dozen in all – will form a coalition to lobby Congress and the U.S. Department of Health and Human Services.

More details on the coalition will be released next month, according to Dauner.

“We believe Medicaid reform nationally is where it’s headed,” he said.