In this season of discontent, anyone rooting for the Affordable Care Act should be crying in his or her beer by now.
Just over the past week, an appeals court in Atlanta ruled against the constitutionality of the individual mandate one of the crucial underpinnings of the ACA. Debt-ceiling negotiations in Washington, meanwhile, put future funding for the ACA in jeopardy. If the New Austerity holds, will federal and state governments have the money to subsidize healthcare for millions of Americans.
Meanwhile, at least two governors are returning federal grants to help jump-start health benefits exchanges. Kansas announced Aug. 9 that it will return $31.5 million in federal money because it doesn't believe the federal government will be able to fully fund the exchanges. Every state should be preparing for fewer federal resources, not more, Republican Gov. Sam Brownback said. Oklahoma also returned its exchange grant.
The next step for the legal challenges is likely to be the U.S. Supreme Court, but until then, state governments, insurers, pharma companies anyone with a stake in the law's implementation are forced to continue planning for the exchanges and the upcoming expansion of Medicaid as if it will occur.
Granted, the latest court ruling doesn't strike down the entire law, just the part that requires most individuals in the United States to purchase health insurance. Many believe that without healthy people buying into the marketplace, though, insurers will refuse to participate in the exchanges, fearing they'd have only the sickest and poorest Americans to insure.
That's definitely a risk, but there's also this logic: maybe most of the uninsured who can buy into exchanges want to do so regardless of whether they're forced. After all, the penalty in the ACA for not complying with the individual mandate is so weak that anyone inclined to take the penalty over the health insurance would do so.
If the ACA collapses, it's most likely to be for budget reasons. If Congress is really serious about cutting the budget, and taxes (or revenue whatever you're going to call it) aren't increasing, the ACA is far too large a target to evade the crosshairs of budget cutters.
It's enough to make one thirst for the good old days, when the only threat to the ACA seemed to come from political wrangling.