Complete Story


Affordable Care Act Upheld: Now What?


Last week’s U.S. Supreme Court decision affirming the Patient Protection and Affordable Care Act (ACA), except for the provision mandating states to expand Medicaid eligibility, has implications in Ohio. Some of these implications include our state’s movement to incorporate Managed Care Organizations (MCOs) into Medicaid case management; Medicaid waiver programs either already in place or seeking approval from the federal government that mirror provisions of the ACA; and now it is uncertain if Ohio will expand eligibility as previously required under the ACA.
The primary impact of the decision is to ensure that the federal government will not roll back existing Medicaid programs in states for lack of compliance with the ACA. The decision also effectively limits the broad expansion of Medicaid to more recipients. Otherwise, the law was largely left intact, and providers should expect to see more in coming months on the following initiatives as they are implemented:
  • Collaboration with Accountable Care Organizations (ACOs);
  •  A post-acute bundling pilot;
  • Broad innovation initiatives from the Centers for Medicare and Medicaid Innovation (CMMI);
  • Rebasing (reduction) of home health rates over 4 years starting in 2014;
  • Reduced payments-both in decreased market basket updates and productivity adjustments;
  • The Independent Payment Advisory Board (IPAB), to push MedPAC directive.


However, the decision also brings to the forefront some interesting questions:
  • Going forward there is still likely to be a significant uninsured population, since states may choose not to participate in the expanded Medicaid program. If states do opt in, Medicaid rolls are likely to significantly increase; will sufficient funds follow such increases?
  • How will private insurers deal with new enrollees under the Act’s provisions and how will states review and monitor insurer rates and compliance? The burden is now on both insurers and regulators to act quickly under the Act.
  • From an employer perspective, the waiting game is over – and now compliance is a coming issue; will we see more litigation as a result? Also, a portion of the ACA requires unionized employers to recognize bargaining rights rather than unilaterally implementing new policies, creating new points for bargaining sessions.
  • Politically, all is dependent now on the fall election – depending on who wins will tell us what to expect in 2013 and beyond!
We will continue forward on our advocacy efforts on the state and federal level, knowing more clearly what the parameters of our overriding issues are. Stay tuned for more updates via alerts, The Source, and The Pulse.

For questions or comments about Midwest Care Alliance’s advocacy efforts, contact Jeff Lycan at (614) 545-9016 or or Katie Rogers Colgan at (614) 545-9032 or