Harmony Healthcare Blog

SCOTUS Decision in King v Burwell: Crisis Averted?

Posted by The Harmony Team on Fri, Jun 26, 2015

Edited by Kris Mastrangelo

affordable-care-act-534662-editedACA is here to stay, for now.

On June 25, 2015 the Supreme Court Of the United States (SCOTUS) published its decision in King v Burwell which upholds the availability of federal subsidies for insurance purchased through federal as well as state exchanges. The SCOTUS found that “Congress passed the Affordable Care Act (ACA) to improve health insurance markets, not to destroy them” therefore the interpretation of the Act should reflect Congress’ intent. According to the American Health Care Association, this ruling signals that the ACA is here to stay, at least for now. The court decision even went further than expected and limits future challenges to the law which puts an end to the uncertainty associated with repeated challenges to the controversial health care law.

What was at stake for seniors?

In short, the solvency of the Medicare program and the loss of projected direct savings to seniors due to lower drug costs and preventive services with no out of pocket expenses; all of which has been guaranteed by the passage of the ACA. The projected savings in the Medicare Program is realized using a mix of reductions in provider reimbursement and other cost cutting measures implemented throughout the healthcare system to lower health care costs including premium payments. The current system relies heavily on the creation of a diverse risk pool. This means that younger and/or healthier populations are required to participate in the marketplace as much as older and/or sicker populations to ensure costs are lower throughout. The availability of federal subsidies is an important factor determining participation by families or individuals who are unable to afford health insurance and whose incomes may be too high to qualify for Medicaid. It is estimated that an adverse ruling would affect close to 6 Million Americans with health insurance. This would essentially upend the law and destabilize the entire health care system.

According to Kris Mastrangelo, OTR/L, LNHA, MBA, President and CEO, Harmony Healthcare International, “The recent SCOTUS decision is good news for a large portion of America’s seniors who rely on Medicare and ACA for their health insurance. The court’s clarification that individuals can get their insurance through either state or federal exchanges will help some of America’s most vulnerable citizens by alleviating additional financial burdens and allowing for greater flexibility and choice.” 

SNFs must prepare for changes.

On the one hand we can breathe a sigh of relief that there is certainty in the law, but Mastrangelo also warned that “providers must prepare for the anticipated decreases in reimbursement rates and the shift to increased scrutiny on quality of care measures.” The new requirements promulgated under the health care law are challenging for some providers but it is also a great opportunity for providers to pay attention to their corporate compliance programs and ensure that they are standing by their mandate of providing great care. In the long run, these measures will strengthen the industry and prolong the life of our Medicare program.  

For more information on the SCOTUS decision and how you can better prepare your SNF's quality, documentation and compliance programs, please contact Harmony Healthcare by clicking here or calling our office at (800) 530-4413.


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Tags: Affordable Care Act, ACA, SCOTUS

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