Join us below at 1 P.M. Eastern time on Thursday (June 28) for a live 30-minute online chat with economist Meredith Rosenthal of Harvard’s School of Public Health, who will discuss the future of health care in the U.S. following the Supreme Court ruling on the Affordable Care Act (ACA). We invite you to post chat questions in advance in the comments below.
The ACA, signed into law in 2010 by President Obama, is the most profound change to U.S. health care in more than four decades. It was designed primarily to extend health insurance to 32 million uninsured Americans. The challenge before the Supreme Court put individuals’ access to health care at stake.
Rosenthal, who helped write a brief (pdf) in support of the ACA that was reviewed by the justices, will answer questions today about the individual mandate (which requires Americans to buy insurance by 2014 or face a penalty), how it and the nation’s health care will be affected in light of the ruling, and what’s next for consumers and health care providers. We will turn on the capacity to log-in to the chat box below around 12:50 P.M. EDT.
CHAT TRANSCRIPT
sciam_live Hi early arrivals. This is Robin Lloyd, news editor at Scientific American. I’ll be hosting our live chat in 10 min.
Meredith Rosenthal Hello.
sciam_live Welcome, Dr. Rosenthal. Hi everyone. It’s about time to start, so please allow me to introduce Meredith Rosenthal, our guest today. Dr. Rosenthal is an economist at Harvard’s School of Public Health and she’s an expert on the individual mandate. Dr. Rosenthal helped to write a brief in support of the Affordable Care Act (health care reform). An ‘amicus brief’. You can read the brief here: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0CFcQFjAD&url=http%3A%2
sciam_live So let’s begin! Hi Dr. Rosenthal. Thank you so much for joining us. This must be an exciting day for someone who was so involved in the ACA ruling.
Meredith Rosenthal It is. The decision was a long time coming—and the ACA itself was a long time coming.
sciam_live What was your reaction today to the ruling?
Meredith Rosenthal First, I hope its okay to parse my reaction in terms of my personal support for coverage reform and what the decision means in practical terms.
sciam_live Of course.
Meredith Rosenthal Personally, I was elated. I believe that universal coverage is a goal worth pursuing and the ACA puts us on the path. As an economist, I see this decision as critical for obtaining the full impact of the array of insurance reforms and public coverage expansions that are at the heart of the ACA. Had the individual mandate been invalidated, the remaining provisions of the ACA would have been less effective.
Fred Guterl Interesting that you say this puts us on the path to universal coverage. I would be interested to know what’s likely to be the next step?
sciam_live (Fred Guterl is Scientific American’s executive editor.)
Meredith Rosenthal To Fred’s comment: I think a reform that expands coverage in the forms that Americans have now is the most practical approach. Going forward we will need additional subsidies and most importantly more affordable options to get us to universal coverage.
Gary Calvert Penalty vs. tax…is there really a difference other than semantics?
Meredith Rosenthal Penalty vs. tax. As an economist, I see no difference.
cgorman Doesn’t the U.S. still need to rein in rising health care costs—which could bankrupt the country if left unchecked?
sciam_live (Christine Gorman is Scientific American’s senior health editor.)
Meredith Rosenthal Health care cost control is really the essential next step to sustaining the gains that the ACA brings and going further. Some important efforts in this direction are embedded in the ACA but there is more to be done. I think that will be easier to address now.
ShriyaKothur Hello, I would like to know a little more about how today’s decision impacts health care providers.
Meredith Rosenthal In terms of impact on providers, for the most part they gain from the ACA—more patients with coverage means less bad debt. There are some provider payment changes for Medicare in the ACA but those are really separate from the coverage provisions.
aschmeic I’ve heard concerns about how healthcare orgs are not prepared to deal with the massive influx of new consumers.
Meredith Rosenthal How will providers deal with the onslaught of new patients? This is something we don’t have great evidence on.
Meredith Rosenthal In Massachusetts there was a transitional stage where access problems worsened but that was relatively brief.
Tina Fanetti How will this lower costs?
Meredith Rosenthal Coverage expansion alone will not lower costs. There are payment and delivery system reforms being implemented now that will. Of course, we had relatively few uninsured here at the time our coverage reforms went into effect. Surely there will be a period of strain.
cgorman Sounds like the 2010 law as really about insurance reform; we are still waiting for reform of the health care system.
Fred Guterl I’m hearing a lot of people worry about the burden of this ’tax’ on the jobless. Is that a valid concern?
Meredith Rosenthal The individual mandate only applies if the individual can afford a qualifying plan—in terms of a threshold percentage of income. So the mandate would be unlikely hurt the jobless.
strategicchem From an economic standpoint, how will HCA help our economy?
strategicchem How much more in taxes will a family earning $100K a year have to pay if they already have health insurance?
Anna Kuchment Do you have a sense of how much a family health insurance plan might cost now as compared to before the ACA?
Meredith Rosenthal In terms of the implications of the ACA for the cost of insurance to the currently insured, we have reason to believe it will lower costs. That last statement would apply to an identical plan—if someone has a very skimpy plan now that won’t qualify as real coverage. Then the price would go up—but of course so would the coverage.
Tina Fanetti But what if all you can afford is the skimpy plan?
aschmeic Has dental been addressed or thought about in any discussions? So important to overall health.
Fred Guterl (There are so many good questions I think we’re going to need to clone Dr. Rosenthal ;)
strategicchem What else is can we be mandated to do?
Tina Fanetti strategicchem…if it’s called a tax I’m guessing everything.
Gary Calvert That’s why I asked about penalty vs. tax. Congress is going to have a field day running our lives lol.
David Eisinger Does the individual mandate fundamentally change the relationship of the government and the people, or are there precedents?
Gary Calvert Do you foresee employers dumping employees’ health coverage benefits? If not, why not?
strategicchem I’m seeing things such as a 2.5 percent tax on AGI and an employer mandate tax per employee. Is this true?
Meredith Rosenthal The ACA addresses affordability as noted earlier by exempting people from the mandate if they can’t afford a plan and by subsidies.
Tina Fanetti But who decides what is affordable?
Meredith Rosenthal Those subsidies are available on a sliding scale up to an income of four times the Federal Poverty Level. Affordability is specifically defined in the ACA. It is based on expert opinion and data.
sciam_live What’s the current federal poverty level?
cgorman Federal poverty level is currently $27,010 for family of four
strategicchem So if poor people can’t pay the mandate but still get benefits then where does the money come from?
Meredith Rosenthal The poorest populations get coverage through Medicaid, which is a joint state-Federal program. And then the subsidies assist those who do not qualify for Medicaid but still need assistance (again up to four times the FPL).
Mark Patla What about the Supreme Court’s ruling on Medicaid? Could the poor be hurt by it?
Meredith Rosenthal It is hard to say right now what the impact of the Medicaid component of the ruling will be. Certainly Congress felt that this extra nudge was needed to ensure full participation. But the money coming from the Feds is substantial. Moreover, it is likely that providers and consumer advocates will pressure states to participate in the Medicaid expansions.
cgorman Re Medicaid decision: I assume it won’t affect those who fall under poverty level but rather the ‘working poor’.
Meredith Rosenthal The Medicaid expansion in the ACA is for the poorest of the poor—if working, then not well remunerated.
aschmeic Will be interesting to see states with vastly different pops and their new challenges/successes
aschmeic Is Massachusetts the only state that has done this before? Where did we get data on how this works?
Meredith Rosenthal It is true that Massachusetts is the model for the ACA and most of what we know comes from there. But there are pieces of the ACA that other states have adopted in the past—the employer mandate, for example. In MA, we learned that the combination of individual mandate and insurance market reforms led to rapid coverage expansion. Costs of health plans general decreased for individuals. Access improved (with the caveat I mentioned). And as I noted before, the cost trend was basically the same—in terms of per capita spending. So the MA legislature is making the hard choices about how to address affordability in order to preserve coverage. This will no doubt be the next chapter in Washington as well.
sciam_live @aschmeic: Here is a Scientific American blog post I wrote about some of what was learned in Massachusetts: http://goo.gl/xQemk. More health care links: https://www.scientificamerican.com/report.cfm?id=antibiotic-resistance-bacteria-in-depth; personalized medicine report: https://www.scientificamerican.com/report.cfm?id=personalized-medicine
aschmeic So more people were covered, at the same cost?
Meredith Rosenthal Sorry, no—coverage costs money—more people covered increase total spending. But the per capita spending trend was basically unaffected, confirming what we suspected. Spending trends are driven by care delivery factors such as the way we pay doctors, the advance of health care technology, etc. Some advocates had hoped that covering people would increase prevention and the benefits would be so great that it would save money.
Fred Guterl Meredith, this is awesome—thanks!
sciam_live OK, everyone, I think that’s about it. Thank you for participating. And especially a big thanks to Dr. Rosenthal of Harvard for her expertise and fast answers to a flurry of questions.
Josi Kneisel Thank you!
sciam_live Bye, all.
The ACA, signed into law in 2010 by President Obama, is the most profound change to U.S. health care in more than four decades. It was designed primarily to extend health insurance to 32 million uninsured Americans. The challenge before the Supreme Court put individuals’ access to health care at stake.
Rosenthal, who helped write a brief (pdf) in support of the ACA that was reviewed by the justices, will answer questions today about the individual mandate (which requires Americans to buy insurance by 2014 or face a penalty), how it and the nation’s health care will be affected in light of the ruling, and what’s next for consumers and health care providers. We will turn on the capacity to log-in to the chat box below around 12:50 P.M. EDT.
CHAT TRANSCRIPT
sciam_live Hi early arrivals. This is Robin Lloyd, news editor at Scientific American. I’ll be hosting our live chat in 10 min.
Meredith Rosenthal Hello.
sciam_live Welcome, Dr. Rosenthal. Hi everyone. It’s about time to start, so please allow me to introduce Meredith Rosenthal, our guest today. Dr. Rosenthal is an economist at Harvard’s School of Public Health and she’s an expert on the individual mandate. Dr. Rosenthal helped to write a brief in support of the Affordable Care Act (health care reform). An ‘amicus brief’. You can read the brief here: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0CFcQFjAD&url=http%3A%2
sciam_live So let’s begin! Hi Dr. Rosenthal. Thank you so much for joining us. This must be an exciting day for someone who was so involved in the ACA ruling.
Meredith Rosenthal It is. The decision was a long time coming—and the ACA itself was a long time coming.
sciam_live What was your reaction today to the ruling?
Meredith Rosenthal First, I hope its okay to parse my reaction in terms of my personal support for coverage reform and what the decision means in practical terms.
sciam_live Of course.
Meredith Rosenthal Personally, I was elated. I believe that universal coverage is a goal worth pursuing and the ACA puts us on the path. As an economist, I see this decision as critical for obtaining the full impact of the array of insurance reforms and public coverage expansions that are at the heart of the ACA. Had the individual mandate been invalidated, the remaining provisions of the ACA would have been less effective.
Fred Guterl Interesting that you say this puts us on the path to universal coverage. I would be interested to know what’s likely to be the next step?
sciam_live (Fred Guterl is Scientific American’s executive editor.)
Meredith Rosenthal To Fred’s comment: I think a reform that expands coverage in the forms that Americans have now is the most practical approach. Going forward we will need additional subsidies and most importantly more affordable options to get us to universal coverage.
Gary Calvert Penalty vs. tax…is there really a difference other than semantics?
Meredith Rosenthal Penalty vs. tax. As an economist, I see no difference.
cgorman Doesn’t the U.S. still need to rein in rising health care costs—which could bankrupt the country if left unchecked?
sciam_live (Christine Gorman is Scientific American’s senior health editor.)
Meredith Rosenthal Health care cost control is really the essential next step to sustaining the gains that the ACA brings and going further. Some important efforts in this direction are embedded in the ACA but there is more to be done. I think that will be easier to address now.
ShriyaKothur Hello, I would like to know a little more about how today’s decision impacts health care providers.
Meredith Rosenthal In terms of impact on providers, for the most part they gain from the ACA—more patients with coverage means less bad debt. There are some provider payment changes for Medicare in the ACA but those are really separate from the coverage provisions.
aschmeic I’ve heard concerns about how healthcare orgs are not prepared to deal with the massive influx of new consumers.
Meredith Rosenthal How will providers deal with the onslaught of new patients? This is something we don’t have great evidence on.
Meredith Rosenthal In Massachusetts there was a transitional stage where access problems worsened but that was relatively brief.
Tina Fanetti How will this lower costs?
Meredith Rosenthal Coverage expansion alone will not lower costs. There are payment and delivery system reforms being implemented now that will. Of course, we had relatively few uninsured here at the time our coverage reforms went into effect. Surely there will be a period of strain.
cgorman Sounds like the 2010 law as really about insurance reform; we are still waiting for reform of the health care system.
Fred Guterl I’m hearing a lot of people worry about the burden of this ’tax’ on the jobless. Is that a valid concern?
Meredith Rosenthal The individual mandate only applies if the individual can afford a qualifying plan—in terms of a threshold percentage of income. So the mandate would be unlikely hurt the jobless.
strategicchem From an economic standpoint, how will HCA help our economy?
strategicchem How much more in taxes will a family earning $100K a year have to pay if they already have health insurance?
Anna Kuchment Do you have a sense of how much a family health insurance plan might cost now as compared to before the ACA?
Meredith Rosenthal In terms of the implications of the ACA for the cost of insurance to the currently insured, we have reason to believe it will lower costs. That last statement would apply to an identical plan—if someone has a very skimpy plan now that won’t qualify as real coverage. Then the price would go up—but of course so would the coverage.
Tina Fanetti But what if all you can afford is the skimpy plan?
aschmeic Has dental been addressed or thought about in any discussions? So important to overall health.
Fred Guterl (There are so many good questions I think we’re going to need to clone Dr. Rosenthal ;)
strategicchem What else is can we be mandated to do?
Tina Fanetti strategicchem…if it’s called a tax I’m guessing everything.
Gary Calvert That’s why I asked about penalty vs. tax. Congress is going to have a field day running our lives lol.
David Eisinger Does the individual mandate fundamentally change the relationship of the government and the people, or are there precedents?
Gary Calvert Do you foresee employers dumping employees’ health coverage benefits? If not, why not?
strategicchem I’m seeing things such as a 2.5 percent tax on AGI and an employer mandate tax per employee. Is this true?
Meredith Rosenthal The ACA addresses affordability as noted earlier by exempting people from the mandate if they can’t afford a plan and by subsidies.
Tina Fanetti But who decides what is affordable?
Meredith Rosenthal Those subsidies are available on a sliding scale up to an income of four times the Federal Poverty Level. Affordability is specifically defined in the ACA. It is based on expert opinion and data.
sciam_live What’s the current federal poverty level?
cgorman Federal poverty level is currently $27,010 for family of four
strategicchem So if poor people can’t pay the mandate but still get benefits then where does the money come from?
Meredith Rosenthal The poorest populations get coverage through Medicaid, which is a joint state-Federal program. And then the subsidies assist those who do not qualify for Medicaid but still need assistance (again up to four times the FPL).
Mark Patla What about the Supreme Court’s ruling on Medicaid? Could the poor be hurt by it?
Meredith Rosenthal It is hard to say right now what the impact of the Medicaid component of the ruling will be. Certainly Congress felt that this extra nudge was needed to ensure full participation. But the money coming from the Feds is substantial. Moreover, it is likely that providers and consumer advocates will pressure states to participate in the Medicaid expansions.
cgorman Re Medicaid decision: I assume it won’t affect those who fall under poverty level but rather the ‘working poor’.
Meredith Rosenthal The Medicaid expansion in the ACA is for the poorest of the poor—if working, then not well remunerated.
aschmeic Will be interesting to see states with vastly different pops and their new challenges/successes
aschmeic Is Massachusetts the only state that has done this before? Where did we get data on how this works?
Meredith Rosenthal It is true that Massachusetts is the model for the ACA and most of what we know comes from there. But there are pieces of the ACA that other states have adopted in the past—the employer mandate, for example. In MA, we learned that the combination of individual mandate and insurance market reforms led to rapid coverage expansion. Costs of health plans general decreased for individuals. Access improved (with the caveat I mentioned). And as I noted before, the cost trend was basically the same—in terms of per capita spending. So the MA legislature is making the hard choices about how to address affordability in order to preserve coverage. This will no doubt be the next chapter in Washington as well.
sciam_live @aschmeic: Here is a Scientific American blog post I wrote about some of what was learned in Massachusetts: http://goo.gl/xQemk. More health care links: https://www.scientificamerican.com/report.cfm?id=antibiotic-resistance-bacteria-in-depth; personalized medicine report: https://www.scientificamerican.com/report.cfm?id=personalized-medicine
aschmeic So more people were covered, at the same cost?
Meredith Rosenthal Sorry, no—coverage costs money—more people covered increase total spending. But the per capita spending trend was basically unaffected, confirming what we suspected. Spending trends are driven by care delivery factors such as the way we pay doctors, the advance of health care technology, etc. Some advocates had hoped that covering people would increase prevention and the benefits would be so great that it would save money.
Fred Guterl Meredith, this is awesome—thanks!
sciam_live OK, everyone, I think that’s about it. Thank you for participating. And especially a big thanks to Dr. Rosenthal of Harvard for her expertise and fast answers to a flurry of questions.
Josi Kneisel Thank you!
sciam_live Bye, all.
