By: Kimberly J. Kockler
June 28, 2012
In a landmark and heavily anticipated decision, the United States Supreme Court ruled on June 28 that the individual mandate provision within the Affordable Care Act (ACA), the federal health care reform law, is constitutional. This also means that the insurance market reforms included in the federal health care reform law, including a mandate that insurers provide coverage to anyone who seeks it, even those with pre-existing conditions, remain as part of the law.
So why is this decision important to residents of northeastern and north central Pennsylvania?
The individual mandate was added to the federal health care reform law as a way to compel most consumers to purchase health insurance. This was the most discussed and most controversial measure of the health care reform law, raising the issue of whether the federal government has the power to compel consumers to purchase something. The Supreme Court ruled, in this case, that it does.
That decision is important because having as many individuals as possible in the health insurance pool, especially healthy individuals, is necessary for the other market reforms included in the federal health care reform to work as intended.
The Court’s ruling that the individual mandate is constitutional also maintains the incentive for healthy individuals to buy health insurance before they get sick. In fact, recent studies from several independent experts, including the Congressional Budget Office, show that severing the individual mandate from the other market reforms of federal health care reform would have led to increases in both the number of uninsured Americans and the cost of health insurance.
Yet the individual mandate, and the other insurance market reforms that were upheld by the Court, are not enough to address the driving issue of rising health care costs.
That is why all stakeholders in the health care system need to take a unified and multi-faceted approach to addressing rising health care costs. And following the Court’s decision, health insurers such as Blue Cross of Northeastern Pennsylvania (BCNEPA) will continue to implement measures that have already shown promise in addressing rising costs.
For example, health insurers are already working with doctors and hospitals nationwide to implement accountable-care models and other patient-centered payment reforms that reward the quality of care a patient receives. Health insurers are also offering an array of tools that promote wellness and that help manage costly chronic conditions.
Managing chronic conditions is important because according to the Centers for Disease Control and Prevention (CDC), chronic diseases account for about 75 percent of the nation's aggregate health care spending. These chronic conditions are often brought on by obesity, high blood pressure, high cholesterol and lack of physical activity, and are largely preventable.
To help address the root causes of costly chronic conditions, health insurers like BCNEPA have developed successful wellness programs for their members and customers. At BCNEPA, every member has the opportunity to work with health coaches to develop a personalized health and wellness program to better manage chronic conditions with our Blue Health Solutions program.
Employers are also finding success with wellness programs. In fact, recent studies show that employees who are engaged in a wellness program miss less days of work, are more productive and can help slow increases in health care cost trends.
Even with these successes, the greater challenge ahead following the Court’s decision is the long-term ability to control costs as access to care is improved. And that is why, as a major insurer and employer in the northeastern and north central regions of the Commonwealth, Blue Cross of Northeastern Pennsylvania urges our policymakers to carefully view what the Court has ruled and how the Affordable Care Act is further implemented to ensure it is benefiting consumers.
Our members, and all residents of the 13 counties we serve, deserve true reform that controls escalating costs through balanced health insurance pools, health and wellness programs, disease prevention and chronic care management, and a refocusing of resources towards preventive care and systems that pay providers based on performance, including their ability to keep patients healthy.
Kimberly J. Kockler is Vice President of Government Affairs for Blue Cross of Northeastern Pennsylvania