Top reporters ask, ‘Will the ACA survive?’

Even as the Affordable Care Act transforms the nation’s health care system, its future remains uncertain. But one thing is clear: No matter what happens, the law and its impact will remain a central subject for health care journalists for years to come.

Speakers Julie Appleby of Kaiser Health News and Sarah Kliff of Vox tackled the topic in a Thursday session at the Association of Health Care Journalists’ conference that drew a large crowd. They touched on the recent history of the law, how it’s being implemented across the nation and what could happen in the future. And they provided jumping-off points for stories.

Appleby described the King v. Burwell Supreme Court case, which will decide whether health plan subsidies can be given out in 37 states. This is a very big deal, she said, because 87 percent of the 11.7 million people who have so far signed up for health plans under the ACA have gotten subsidies.

“If the court rules against the administration in this case, the subsidies could stop almost immediately,” Appleby said. 

That could lead many people to drop coverage as their plans become much more expensive, she said; enrollment could decline by 70 percent, or 9 million people.

Meanwhile, she said, the ACA has successfully helped reduce the rate of uninsured adults under age 65 from 18 percent in the third quarter of 2013 to 11.9 percent today.

Appleby pointed out that many legal analysts say they don’t think the court will rule against the subsidies, but no one is sure. She suggested journalists look at what state lawmakers are doing around contingency planning just in case the subsidies go away.

Kliff talked about polarization in Washington around the ACA – how the House voted to repeal it 67 times since it became law, for example, and how the 2016 election may change the political dynamics at play.

She discussed recent Congressional action on how doctors get paid: a $214 billion Medicare payment reform plan passed this month and approved by Obama. The upshot is that doctors will get reimbursed more for value and less for the volume of services they provide, Kliff said. She suggested that journalists may want to explore what this means for hospitals and doctors in their states.

Kliff also talked about “Obamacare 2.0,” or what may come next in the evolution of health reform, especially as Democrats turn their attention to health care costs.

As debate continues in Washington, Kliff said, many states are still working to enroll people in expanded Medicaid as well as private health plans purchased on exchanges. She said they have already captured many of the uninsured, but not all of them – and one story may be to look at what groups are doing to raise enrollment among hard-to-reach groups.

Kliff and Appleby suggested several more story lines to chase, including:

• How much do states spend on exchanges and what problems have they faced getting people to sign up for coverage?

• Who is signing up and who is not? Avalere Health, an advisory company focused on health care business strategy, looked at enrollment of people whose incomes are more than twice the federal poverty level and found that the subsidies were not so enticing for these people.

• What does it mean to people when less expensive exchange plans offer narrow networks of providers?  So far, there hasn’t been much information on whether the quality of care is worse in these narrow networks.

To be sure, whatever the future holds for the ACA, the story possibilities are almost endless.

Image by DonkeyHotey via Flickr.