Monday , July 26 2021

Large GPOs involved in Obamacare ruling push to close health coverage gaps

Leaders in the industry say last week’s U.S. Supreme Court’s decision to uphold the Affordable Care Act could make it tougher for future lawsuits to challenge the law. The ruling also frees up New York state to pursue providing coverage to those who are still uninsured.

“Since passage of the ACA, New York has done more over the last decade than almost any other state to expand healthcare coverage, bolster services for its most vulnerable residents and improve the quality of care,” said Eric Linzer, president and CEO of the New York Health Plan Association, which represents 28 members. The court’s decision “will ensure that the coverage millions of New Yorkers depend on remains protected.”

New York leaders played a role in the court’s decision, said Kenneth Raske, president of the Greater New York Hospital Association. GNYHA had joined with other hospital associations in filing an amicus brief in defense of the law, led by Attorney General Letitia James and other state attorneys general, Raske said.

“We strongly support the ACA, which has made healthcare accessible to so many Americans, and we are grateful that it has once again survived legal challenge,” Raske added.

The ACA has withstood two previous legal challenges in the Supreme Court.

“We hope this case once and for all stops these lawsuits, which unnecessarily endanger health insurance coverage for millions of patients across New York and across the country,” said Dr. Joseph Sellers, president of the Medical Society of the State of New York.

The court victory might not necessarily spell the end of challenges from Republicans, but it will make it harder for future attempts, said Diana Silver, associate professor of public health policy and management at the New York University School of Global Public Health.

“This eliminated another way for opponents to get in,” Silver said. Proponents had been on edge since the Supreme Court announced it would take the case, and the odds appeared stacked in favor of the opponents, she added.

Thursday’s decision frees up time and energy for New York and other states to focus on extending coverage to those who are not yet insured, she said.

With more than 95% of residents with insurance, the focus now should be on achieving the goal of universal healthcare, Linzer said.

Although the ACA did not expand the state’s Medicaid benefits much, as they were already broad, it did ensure comprehensive coverage—eliminating exclusions for pre-existing-conditions and payment limits as well as establishing preventive care—for New Yorkers, Silver said.

The court’s decision also ensures the state’s accountable-care organizations—provider groups that work to improve health outcomes while reducing costs—can continue to flourish, she said.

“The ACA had enabled a shift of funding for ACOs to care not just about providing services but also about outcomes,” she said.

As of January, there were about 477 ACOs nationally, of which about 30 were in New York.

“Those entities would not have been able to function had ACA been struck down,” Silver said.

This story first appeared in our sister publication, Crain’s New York Business.

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