KHN’s ‘What the Health?’: The ACA lives

Reviewed by Emily Henderson, B.Sc.Jun 18 2021

For the third time in nine years, the Affordable Care Act has survived a constitutional challenge at the Supreme Court. In a 7-2 decision, the court ruled that the states and individuals who filed the latest challenge lacked standing to sue.

Meanwhile, Democratic lawmakers are looking for ways to expand health benefits as they pull together spending plans on Capitol Hill. And criticism is growing of the Food and Drug Administration, which approved a controversial drug to treat Alzheimer's disease over the recommendation of its own expert outside advisers.

This week's panelists are Julie Rovner of KHN, Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Rachel Cohrs of Stat.

Among the takeaways from this week's episode:

• The ACA decision Thursday was a signal that the Supreme Court is moving beyond Republican arguments that the landmark health law is unconstitutional or should be overturned. At least one other challenge is still working its way through the court system, and the Supreme Court may still be called on to settle questions about specific provisions or aspects of implementation. But it appears that legal challenges are no longer an existential threat to the overall law.
• The first major ACA case that made its way to the Supreme Court was one brought by business groups. But over time, industry has come to accept the ACA and most businesses do not want to see more challenges that threaten the entire law.
• The court's decision leaves Republicans in a tough position. Their opposition to the law has become a standard part of the party's identity, yet Republican lawmakers never put forward a strong vision for a replacement or a path to meeting the country's health care needs if the ACA were overturned. Because health care policy issues are not front and center on Capitol Hill at the moment, Republicans have time to formulate a new strategy. But they may need a message when Democrats move soon to make permanent the enhanced insurance subsidies for plans on the ACA marketplace.
• The congressional clock is ticking as Democrats strategize on a variety of policies, including infrastructure and those health premium subsidies. If bipartisan deals are not made soon, Democratic leaders will likely push to use a complicated process called budget reconciliation that allows some types of bills to be passed by a simple majority in the Senate and not be subjected to a filibuster. Health provisions could be part of such a bill, such as lowering the eligibility age for Medicare, establishing higher insurance subsidies and allowing Medicare to negotiate drug prices.
• One of the most popular options Democrats would like to add to a reconciliation bill would be expanding Medicare benefits to cover dental, vision and hearing care.
• As the country continues to transition to a new normal as the covid pandemic eases, some employers are mandating that workers be vaccinated — but, in some instances, workers are refusing. The issue has already led to a legal fight over a Houston hospital's mandate and is likely to spread. Workers argue that the vaccine has not yet been formally approved by federal regulators, having received only emergency authorization. That could change soon, though, because at least two vaccine makers are asking for a former approval from the FDA.

Also this week, Rovner interviews Andy Slavitt, who ran Medicare and Medicaid in the Obama administration and most recently helped head up the covid response effort for President Joe Biden.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: Politico Magazine's "How the Anti-Abortion Movement Used the Progressive Playbook to Chip Away at Roe v. Wade," by Mary Ziegler and Robert L. Tsai

Joanne Kenen: The Atlantic's "The Texans Challenging Obamacare Have No Standing," by Nicholas Bagley

Rachel Cohrs: KHN's "In Alleged Health Care 'Money Grab,' Nation's Largest Hospital Chain Cashes In on Trauma Centers," by Jay Hancock

Mary Ellen McIntire: The New York Times' "Many Post-Covid Patients Are Experiencing New Medical Problems, Study Finds," by Pam Belluck

Also: Roll Call's "CDC Issues Guidance for Treating 'Long COVID' Patients," by Mary Ellen McIntire