Onward And Upward For The ACA After King v. Burwell

Chief Justice Roberts, in the majority opinion in King v. Burwell, confirmed that the only insurance spiral now is one onward and upward for the millions of Americans who will benefit from the peace of mind and protections of the Affordable Care Act (ACA) as passed by Congress and signed by President Obama.

Among the many benefits of the ACA, Exchanges have been operating in some form to increase coverage in every state since 2013. Millions of lives have been changed or saved as a result. Many legal theorists and Supreme Court observers are rightly praising the sound legal reasoning and Constitutional principles in action that led to upholding key aspects of the Affordable Care Act (again).

It is a stark example of the relationship among the three branches created by the Constitution: Legislative drafting and passage, Executive implementation, and Judicial interpretation of language that in this case may have been less than clear. Additionally, the practical implications of the Court’s decision also are particularly salient.

The Example of Massachusetts

Chief Justice Roberts cites the Massachusetts law enacted in 2006 as the model for the ACA’s use of tax credits to support affordability of health insurance coverage for qualified individuals. The Massachusetts law indeed can be considered a model of legislative process, statutory and regulatory substance, and the power of community-based coalitions to sustain its successful impacts on so many lives.

The creation of a new portal through which to obtain health insurance, with subsidies for those who are income-eligible is one similarity between the Massachusetts health reform law of 2006 and the ACA. But also, and most dramatically, parallels between the Massachusetts experience and that of the ACA have been found in the “on the ground” implementation scenarios in neighborhoods and communities over the past five years. In neighboring New England states, as in states throughout the country, broad coalitions formed to support enrollment in ACA Exchanges, irrespective of how they were established.

Those of us who have worked to implement the ACA, as we did in Massachusetts, have well understood: We can build new opportunities for health insurance for millions of Americans, accompanied by the promise of first-time access to free preventive services and new consumer protections, but the millions of uninsured and underinsured will not come if they aren’t aware of the new law, what their insurance options are, and how to enroll.

Navigators and Assisters

The navigators, assisters, brokers, and all who facilitated the enrollment for millions of Americans on the Exchanges became the sine qua non for one of the most significant benefits of the ACA, access to health insurance. They spoke to and met with countless individuals and families, often multiple times each, set up tables and displays at public events and such public places as libraries, going to wherever the people were, and fostered a new culture of the availability of health insurance and assistance in using that new coverage.

No matter the state, no matter the Web address, no matter the governance structure of the Exchange — ALL qualified individuals relied on the opportunity to access tax credits to be able to afford their coverage.

The enrollment assistance provided by armies of navigators and assisters through the Affordable Care Act indeed has mirrored significant investment made by public-private partnerships in Massachusetts to provide enrollment counseling and assistance that contributed to near universal coverage ahead of schedule.

King v. Burwell is a victory for all the navigators, assisters, as well as, above all, the individual beneficiaries of the Affordable Care Act.

And, in the home state of John “Johnny Appleseed” Chapman, that is no “applesauce.”